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Inflicted skeletal injury: a postmortem radiologic-histopathologic study in 31 infants
P K Kleinman1, S C Marks, J M Richmond
1Department of Radiology, University of Massachusetts Medical Center, Worcester 01655, USA.
AJR. American Journal of Roentgenology
|September 1, 1995
Summary
Infants with inflicted skeletal injuries often have multiple fractures, particularly in the ribs and long bone metaphyses. Evidence of healing fractures suggests the need for thorough radiologic examination in suspected abuse cases.
Area of Science:
- Forensic Pathology
- Pediatric Radiology
- Skeletal Trauma Analysis
Background:
- Inflicted skeletal injuries in infants are a critical concern in child abuse investigations.
- Accurate identification and dating of fractures are essential for diagnosis and legal proceedings.
Purpose of the Study:
- To determine the number, distribution, and age of inflicted skeletal injuries in infants using detailed postmortem analysis.
- To compare the efficacy of skeletal surveys, specimen radiography, and histopathology in detecting these injuries.
Main Methods:
- Postmortem examination of 31 infants with confirmed inflicted skeletal injuries.
- High-detail skeletal surveys, specimen radiography, and histopathologic analysis were employed.
- Fracture dating was based on radiologic and histologic criteria, excluding skull fractures from numerical analysis.
Main Results:
- A total of 165 fractures were identified, with ribs (51%) and long bones (44%) being the most common sites.
- Metaphyseal fractures (89% of long bone fractures) were more prevalent than shaft fractures (11%).
- Specimen radiography significantly improved fracture detection rates compared to skeletal surveys alone (92% vs. 58%).
Conclusions:
- Infants experiencing inflicted trauma frequently present with fractures at multiple skeletal sites.
- The fracture patterns in infants differ from older children, with a higher incidence of metaphyseal and rib fractures.
- The presence of healing fractures underscores the importance of comprehensive radiologic assessment in both living and deceased infants suspected of abuse.