Forensic Aspects of Paediatric Fractures: Differentiating Accidental Trauma from Child Abuse

Table of contents :
Foreword
Contents
1: Child Abuse, Non-Accidental Trauma, and Inflicted Injuries
1.1 Defining Child Abuse
1.1.1 Child Abuse
1.1.2 Physical Abuse
1.1.3 Neglect
1.1.4 Emotional/Psychological Abuse
1.1.5 Sexual Abuse
1.1.6 Fabricated or Induced Illness by Parents/Caregivers
1.2 Epidemiology
1.3 Clinical Aspects
1.4 Defining Trauma and Injury
1.5 Cause of Injury
1.5.1 Introduction
1.5.2 Mechanical Trauma
1.5.2.1 Static Loading
1.5.2.2 Dynamic Loading
1.5.3 Non-mechanical Trauma: Physical Agents
1.5.4 Direct and Underlying Cause
1.6 Manner of Injury
1.7 Cutaneous Injuries
1.7.1 Introduction
1.7.2 Blunt-force Trauma: Closed Skin Injuries
1.7.2.1 Erythema
1.7.2.2 Bruises
1.7.2.3 Petechiae
1.7.3 Blunt-force Trauma: Open Injuries
1.7.3.1 Abrasions
1.7.3.2 Lacerations and Avulsions
1.7.3.3 Blunt Penetrating Trauma
1.7.4 Sharp-force Trauma
1.7.4.1 Incisions and Stab Wounds
1.7.4.2 Gunshot Wound
1.7.5 Non-mechanical Trauma: Near Contact with Physical Agents
1.8 Other Injuries
1.8.1 Introduction
1.8.2 Thoracoabdominal Injuries
1.8.2.1 Intrathoracic Injuries
1.8.2.2 Intra-abdominal Injuries
1.9 Objectifying Suspicions of Inflicted Injuries and Non-accidental Trauma
1.10 Characteristics of the Clinical History
1.10.1 Clinical History
1.10.2 The Origin of the Injuries
1.10.3 Delay in Seeking Medical Help
1.10.4 Attitude and Reaction of the Parents/Caregivers
References
2: General Aspects of Fractures in Children
2.1 Introduction
2.1.1 Definition
2.1.2 Epidemiology
2.2 Diagnosis and Differential Diagnosis of Fractures in Children
2.2.1 Clinical Presentation
2.2.2 Differential Diagnosis
2.3 Fracture or Mimic
2.4 Fracture Description
2.4.1 Anatomic Location and Type of Bone
2.4.1.1 Identification of the Fractured Bone
2.4.1.2 Bone Type
Long Bones
Short Bones
Flat Bones
Sesamoid Bones
Irregular Bones
2.4.1.3 Affected Part of the Bone
2.4.2 Type of Fracture and Direction of Fracture Lines
2.4.3 Position and Relationship of the Fracture Components
2.4.4 Complications
2.5 Cause of Fractures (Mechanism)
2.5.1 General Aspects
2.5.2 High-Energy Trauma
2.5.3 Low-Energy Trauma
2.5.3.1 Low-Energy Trauma: Normal Sufficient Bone—Single Load
2.5.3.2 Low-Energy Trauma: Normal Sufficient Bone—Repeated Load
Avulsion Fractures
Fatigue Fractures in Normal Bone: Stress Fractures
2.5.3.3 Low-Energy Trauma: Normal Insufficient Bone
2.5.3.4 Low-Energy Trauma: Abnormal Bone
2.5.3.5 The Use of Terms like Spontaneous and Pathological Fractures in Forensic Paediatrics
2.6 Manner of Fractures (Circumstances)
2.6.1 Intrauterine Fractures
2.6.1.1 Intrauterine Fractures in Normal Bone
2.6.1.2 Intrauterine Fractures in Weakened Bone
2.6.2 Fractures During Birth: Birth Trauma
2.6.2.1 General Aspects of Birth Trauma-Related Fractures
2.6.2.2 Incidence and Prevalence of Fractures Resulting from Birth
2.6.3 Fractures After Birth: Accidental Circumstances
2.6.4 Fractures After Birth: Non-Accidental Circumstances
2.6.4.1 Epidemiology
2.6.4.2 Specificity of Fractures, Sustained in Non-Accidental Circumstances
2.6.4.3 The Value of Haematomas in the Differential Diagnosis Between Accidental and Non-accidental Circumstances
2.6.4.4 Perpetrators and Victims
2.6.5 Fractures After Birth: Other Circumstances
References
3: Radiology in Suspected Child Abuse
3.1 Introduction
3.2 Conventional Radiology
3.2.1 Guidelines
3.2.1.1 American College of Radiology
3.2.1.2 The Royal College of Radiologists and the Society and College of Radiographers
3.2.1.3 Examination on Indication
3.2.2 Adequacy of Examination
3.2.2.1 Number of Views
3.2.2.2 Technique
3.2.2.3 Technical Shortcomings in Making a Skeletal Survey
3.2.2.4 Follow-Up Skeletal Survey
3.3 Bone Scintigraphy
3.3.1 Effectivity of Bone Scintigraphy Versus Conventional Radiology
3.4 Computed Tomography
3.5 Linear Slot Scanning
3.6 Magnetic Resonance Imaging
3.7 Ultrasonography
3.8 Bone Densitometry
3.9 Post-Mortem Imaging
3.10 Radiation Dose in Imaging Suspected Child Abuse
References
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4: Fracture Dating
4.1 Introduction
4.2 Biology of Fracture Repair
4.2.1 Types of Fracture Repair
4.2.1.1 The Inflammatory Phase
4.2.1.2 The Reparative Phase
4.2.1.3 The Remodelling Phase
4.2.2 Factors that Influence Fracture Repair
4.2.2.1 Local Factors
4.2.2.2 Systemic Factors
4.3 Dating Fractures
4.3.1 Radiological Aspects of Fracture Dating
4.3.2 Histological Aspects of Fracture Dating
4.4 The Practice of Fracture Dating in Dutch Forensic Casework
4.4.1 Radiological Imaging Before and After Autopsy
4.4.2 Histological Analysis
4.4.3 Interpretation
4.4.4 Examples of Fracture Dating
References
5: Head
5.1 General Aspects of Head Injuries
5.1.1 Introduction
5.1.2 Injuries to the Scalp and the Bony Tissues of the Skull
5.1.3 Injuries to the Orofacial Soft Tissues and the Intracranial Content
5.2 Injuries of the Scalp
5.2.1 Introduction
5.2.1.1 Anatomy of the Scalp
5.2.1.2 Scalp Injuries
5.2.1.3 Cause and Manner of Scalp Injuries
5.2.1.4 Type and Severity of Scalp Injuries
5.2.2 Cutaneous and Subcutaneous Injuries of the Scalp
5.2.2.1 Introduction
5.2.2.2 Bruises
5.2.2.3 Abrasions, Lacerations, and Avulsions
General Aspects
Trauma After Birth: Accidental Circumstances
Trauma After Birth: Non-accidental Circumstances
5.2.2.4 Traction Alopecia
5.2.2.5 Scalp Injuries, Skull Fractures and Intracranial Injuries
5.2.3 Subgaleal Haematoma
5.2.3.1 Introduction
5.2.3.2 Cause of Subgaleal Haematoma
Traumatic Separation of the Galea from the Periosteum
Migration of Intracranial Blood and/or Liquor to the Subgaleal Space
5.2.3.3 Manner of Subgaleal Haematoma
Intrauterine Trauma
Trauma During Birth