In Battered Child Syndrome (BCS), the radiological finding that is MOST specific and pathognomonic of non-accidental injury (NAI) in infants is:

• A Diaphyseal (shaft) fractures of long bones in different stages of healing
• B Classic metaphyseal lesion (bucket-handle or corner fracture) at growth plate ✓
• C Bilateral subdural haematomas in the frontoparietal region
• D Multiple bilateral rib fractures in posterior paravertebral location

Explanation

The classic metaphyseal lesion (CML) — also called bucket-handle fracture or corner fracture — is considered the MOST specific radiological finding for non-accidental injury in infants. It occurs through a shearing mechanism at the primary spongiosa of the metaphysis when the limb is violently jerked or twisted (as in shaking). The fracture creates a disc of bone at the metaphyseal margin visible as 'corner fractures' on two-view X-ray or a 'bucket handle' on certain projections. While multiple rib fractures and healing diaphyseal fractures are also highly suspicious for NAI, the CML is pathognomonic and is not produced by accidental forces in infants.

Reference: The Essentials of Forensic Medicine and Toxicology (Narayan Reddy), 34th ed.

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Written and medically reviewed by the StethoPrep medical team.