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Pediatric skull fractures: could suture contact be a sign of abuse?
Berna Uçan1, Oğuzhan Tokur2, Sonay Aydın3
1Department of Radiology, Dr. Sami Ulus Training and Research Hospital, Ankara, Turkey.
Insights
Skull fractures contacting two or more sutures are significantly more common in child abuse cases than accidental injuries. This finding may help identify abuse-related head trauma in pediatric patients.
Area of Science:
- Pediatric Traumatology
- Forensic Medicine
- Radiology
Background:
- Skull fractures in young children can result from accidental trauma or abuse.
- Initial evaluations may overlook abusive head trauma, highlighting the need for reliable indicators.
- Distinguishing between accidental and abuse-related fractures is critical for child protection.
Purpose of the Study:
- To determine the prevalence of skull fractures involving sutures in pediatric head trauma.
- To investigate if fracture line contact with sutures can serve as an indicator of abuse in children.
Main Methods:
- Retrospective analysis of 44 pediatric patients with confirmed skull fractures on CT scans (January 2010 - June 2020).
- Recorded patient demographics, head injury type, fracture characteristics (site, location, number), and suture contact.
- Compared suture contact rates between abuse-related and accidental fractures.
Main Results:
- Evaluated 28 abuse-related fractures in 22 children and 25 accidental fractures in 22 children.
- 64% of abuse-related fractures contacted two or more sutures, versus 8% of accidental fractures.
- A significantly higher suture contact rate was observed in abuse-related fractures (p=0.007).
Conclusions:
- Skull fracture contact with two or more sutures is a significant indicator of abuse.
- This finding can aid in differentiating abuse-related head trauma from accidental injuries in pediatric populations.
Purpose:
Skull fractures in infants and young children can occur as a result of both accidental trauma and abuse. 1/3 of children with abuse-related head trauma and 1/5 of children with abuse-related fractures were overlooked during the initial evaluation. In this study, we aim to investigate the prevalence of skull fractures that come into contact with the suture in head traumas caused by accidents and abuse, and also to see if contact of the fracture line with the suture could be used as a sign for abuse in the pediatric population.
Methods:
Forry-four patients with head trauma were retrospectively assessed between January 2010 and June 2020 and were confirmed to have fractures on a brain CT. Patient age, gender, and head injury type were recorded. The fracture site, location and number, the contact of the fracture line with the suture, the name, and number of the suture it came into contact with were determined.
Results:
Twenty-eight skull fractures in 22 children with a diagnosis of child abuse and 25 skull fractures in 22 children due to accidental trauma were evaluated in the same age and gender range. Eighteen (64%) of 28 abuse-related skull fractures were in contact with two or more sutures. Two (8%) of 25 accident-related fractures were related to two or more sutures. Abuse-related fractures had a significantly higher suture contact rate than accident-related fractures (p = 0.007).
Conclusion:
Contact with two or more sutures of a skull fracture is a finding related to abuse rather than accident.
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