Coronal clefts in infants – Rare differential diagnosis of traumatic injuries of vertebral bodies in battered children

• If physical child abuse is suspected skeletal survey is of major importance.
• Physiological clefts in vertebrae have to be known as a physiological variation.
• Vertebral clefts are rarely seen in the first year of life.
• Physiological vertebral clefts cannot be confused with traumatic fractures.

Accidental and nonaccidental spinal injuries are generally rarely seen in infants. If affected, vertebral bodies usually present compression fractures due to forced hyperflexion or hypertension. Radiographic examination of the infantile skeleton can reveal a radiolucent band running through a vertebral body. These so called vertebral clefts are mainly visualized in the lateral spinal radiograph. Usually they can be found in the 1st year of life. Radiological appearance of coronal clefts was compared to that of a traumatic vertebral compression fracture. Clefts were mostly localized in the lumbar spine and had a completely different radiological appearance comparing to a traumatic compression fracture. As coronal clefts can be seen as a result from a retarded ossification of the vertebral bodies in fetal development they are a physiological variant. Due to this different etiology they have to be distinguished from spinal signs of child abuse.