Sieswerda-Hoogendoorn and colleagues [1] interpret a birth-related femoral injury as a classical metaphyseal lesion (CML) but several observations contradict that conclusion. The CML is hypothesized to represent a series of planar microfractures that transgresses the primary spongiosa of the metaphysis as the result of inflicted trauma [2]. In theory, such a precisely located injury would result in a peripheral bone fragment comprised of a solid, thin plate of bone (primary spongiosa) with the attached growth plate and epiphysis. However, Fig. 1A of the authors' paper does not depict a disc-shaped fragment of bone but rather a ring of bone encompassing an arc of approximately 150 degrees that was eloquently identified by ultrasound (Fig. 1). It is much more plausible that this structure actually represents a displaced perichondrial ring as the result of a Salter-Harris type 1 fracture (slipped epiphysis) through the cartilaginous growth plate (physis) rather than the metaphysis.
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