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Published on: August 17, 2017
Post-mortem diagnosis and age estimation of infants' fractures
H Klotzbach1, G Delling, E Richter
1Institute of Legal Medicine, University Hospital Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Germany. klotzbach@uke.uni-hamburg.de
Insights
Accurate detection and dating of infant fractures are crucial for diagnosing child abuse. Histology significantly improves the accuracy of dating fractures, especially in early healing stages.
Area of Science:
- Forensic Pathology
- Pediatric Radiology
- Histopathology
Background:
- Infants' fractures are critical indicators in diagnosing battered child syndrome.
- Accurate dating of fractures aids in establishing timelines of abuse.
Observation:
- Post-mortem evaluation of three infants with multiple, varied-age fractures due to abuse.
- Radiological findings were correlated with autopsy, contact radiography, and histology.
- Histopathology enabled more precise fracture dating, particularly in early healing stages.
Findings:
- Radiological skeletal surveys detected 27 of 44 osseous lesions.
- Recent rib fractures, often missed radiologically, were confirmed histologically.
- Microscopic signs of healing (periosteal thickening, osteoid production) were quantified accurately.
Implications:
- A comprehensive approach combining external examination, skeletal surveys, autopsy, contact radiography, and histology is vital.
- Histological analysis enhances the diagnostic accuracy for infant fractures and abuse cases.
- Improved fracture dating supports legal proceedings and child protection efforts.
Abstract:
Detection and dating of infants' fractures plays an important role in the diagnosis of the battered child syndrome. Under this aspect three cases of infants with multiple fractures of different ages due to child abuse were evaluated post-mortem. Radiological findings were compared with the autopsy results, followed by contact radiography and histopathological assessment. Out of a total of 44 osseous lesions, 27 fractures were diagnosed by post-mortem skeletal survey, additionally 5 recent rib fractures were suspected, 4 of which were confirmed histologically and all were located paravertebrally. The fractures not detected radiologically were mostly recent rib fractures diagnosed or suspected at autopsy or by contact radiography and confirmed histologically. The histological investigation allowed a more precise dating of the fractures, particularly with reference to the early stages of fracture healing. Microscopic signs of fracture healing processes, such as periosteal thickening, osteoid production and calcification of soft callus tissue, can be detected earlier and quantified more accurately. In advanced stages of healing the osseous apposition rate can be measured semiquantitatively up to a certain extent. A scheme involving a careful external investigation, skeletal survey, autopsy, contact radiography and histology has been proven useful for diagnosing and dating infants' fractures.
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