Corner or Bucket-Handle Fractures in Children

A corner fracture refers to injury of the metaphysis, or the growing plate at either end of long bones, such as the femur and tibia. The metaphysis is a piece of cartilage in children, not yet a fully ossified bone. Other names for a corner fracture are a bucket-handle fracture or metaphyseal fracture. Doctors used to classify corner fractures in children as only NAI (non-accidental injuries). This means the injury stemmed from abuse. Today doctors acknowledge the possibility of this fracture occurring accidentally. However, it is still highly suggestive of abuse. As a parent, there is almost nothing worse than realizing that your child has been a victim of abuse at a school or child care facility.

What Does a Corner Fracture Look Like?

Corner fractures typically occur in children two years old or younger. This is because they are small enough for someone to shake them, and they cannot protect their limbs.

Tension and shearing forces on the infant’s limbs can cause metaphysis of long bones and consequent bucket-handle fractures. A corner fracture is the culmination of multiple small fractures (microfractures) across the metaphysis, positioned perpendicularly to the long axis of the bone.

A corner fracture gets the name “bucket-handle” fracture from the shape of the injury. A subacute metaphyseal fracture can form a long arc along the proximal margin of the growing plate. New bone formation can then occur, creating a thickened appearance that simulates a bucket handle. In children under the age of one, corner fractures occur most often in the femur, tibia, and humerus as a result of many microfractures across the metaphysis. Differential horizontal fractures across the metaphysis are not characteristic of blunt force trauma or falls, but rather of child abuse.

A child may show signs of being in pain if he or she has a corner fracture, such as being extra fussy or inconsolable. A child may also show reduced movement in the affected arm, or cringe away when you touch the area. As soon as you notice these signs, take your child in for a comprehensive exam and scans. It is possible he or she has a corner fracture, either by accident or from a situation involving child abuse.

Corner Fractures and Child Abuse

While it’s possible for children to sustain this type of injury on accident (i.e. during physical therapy), it is unusual. Corner fractures are the most specific for NAI, and the most common injuries in abused children. In a circumstance of abuse, an adult may grab, twist, or shake a child’s limb in frustration, causing this type of injury. Shaking the child, causing the limbs to move back and forth, can also cause a bucket-handle fracture. It is difficult to sustain this injury from accidental causes, such as a fall.

According to the Office of Juvenile Justice and Delinquency Prevention, more than 3.3 million cases of child abuse occur in the U.S. every year. About 2,000 children die annually as a result of this abuse. A corner fracture is a red flag for child abuse, and should result in the doctor performing a full-body MRI of the child. This can show other hidden injuries, fractures, and signs of abuse. It is important to investigate the time the fracture occurred to pinpoint whose care the child was in at the time. Then, investigators can see if the caretaker’s story supports the type of injury.

As soon as you discover your child has a corner fracture, investigate the cause of the injury. It is highly likely that someone has abused your child. It may be a babysitter, staff at a daycare center, teacher, or another caregiver. Speak to a child abuse attorney about the circumstances surrounding your child’s injuries. An investigation can be worthwhile to hold the abuser liable for his or her actions, in both the criminal and civil court systems.