Recognition of skeletal fractures in infants: an autopsy technique

Area of Science:

• Forensic Pathology
• Pediatric Radiology
• Child Abuse Detection

Background:

• Complete recognition of injury patterns is crucial for diagnosing child abuse.
• Certain skeletal fractures (posterior rib, scapular, metaphyseal, spinous process) are highly specific to nonaccidental injury in infants.
• These fractures are often occult to standard radiologic and autopsy methods, especially when acute.

Purpose of the Study:

• To present an enhanced autopsy technique for improved recognition of skeletal injuries in infants.
• To increase the opportunity for pathologists to identify subtle or occult fractures indicative of trauma.

Main Methods:

• The technique involves incising and reflecting skeletal muscles to expose bones and costal joints in situ.
• Fractured or atypical bones are removed for processing via maceration in a heated soap-water bath.
• Long bones are replaced with dowels and the chest cavity packed for reconstruction aid.

Main Results:

• The described method enhances visualization of skeletal structures, increasing the detection rate of subtle fractures.
• Maceration allows for detailed examination of bone integrity and morphology.
• The technique aids in the comprehensive documentation of skeletal trauma patterns.

Conclusions:

• This invasive autopsy technique is recommended when reasonable suspicion of acute or remote trauma exists.
• It improves the identification of specific fractures indicative of nonaccidental injury in infants.
• Enhanced skeletal examination is vital for accurate forensic evaluation in suspected child abuse cases.