Can classic metaphyseal lesions follow uncomplicated caesarean section?

Background: Classic metaphyseal lesion (CML) is the term given to a fracture that most often occurs in the posteromedial aspect of the distal femur, proximal tibia, distal tibia, and proximal humerus in infants; this finding is strongly associated with non-accidental injury. Objective: To demonstrate that the CML may occur following simple lowersegment caesarean section (LSCS). Materials and methods: A review of 22 years of an obstetric practice that delivers 8,500 babies per year. Results: We identified three neonates born by elective LSCS, each with distal femoral metaphyseal fractures on postpartum radiographs. All caesarean sections were elective and uncomplicated. External cephalic version was not employed preoperatively. Postpartum radiographs demonstrated a fracture of the distal femoral metaphysis in each neonate, typical of a CML. Conclusion: We propose that a CML can occur in the setting of a simple, elective and uncomplicated LSCS where no external cephalic version is employed.