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Age: 16

Sex: Male

Indication: Trauma

Metopic Suture

Mimicking a Fracture


Findings Relating to the Mimic

  • No acute fracture.  “Zigzag” lucency extending from the nasion to the bregma, consistent with a persistent metopic suture.


Discussion

  • The metopic suture (aka the frontal suture) is a suture that nearly always fuses by 9 months of age, but occassionally will remain unfused into childhood or adulthood (as in this case).
  • The suture extends from the nasion to the bregma (i.e. midline point where the coronal and sagittal sutures meet).
  • This suture is easy to misdiagnose as a fracture.  Knowing the normal location of the metopic suture is key.  Use your 3D reformatted imaging to help you.
  • There also are some general principals that can help you differentiate suture from fracture.  Sutures tend to join other sutures (not cross them) and are more likely to have a “zigzag” appearance.  Fractures may cause diastasis (widening) of sutures, cross sutures, cause depression of fracture fragments, and generally have non-sclerotic margins and a more linear (versus “zigzag”) in appearance.
  • Look for any overlying soft tissue contusion or subjacent extra-axial hemorrhage to increase your suspicion for fracture.


Images

Metopic Suture (red arrow). Illustration by Häggström, Mikael (2014). Typical appearence of the metopic suture (red arrow) where it joins the bregma (blue arrow). Metopic suture (red arrow) extending from the nasion to the bregma.



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