The medicolegal implications of bilateral cranial fractures in infants

There is considerable debate about the possibility of serious injuries associated with skull fractures caused by short-height falls in early childhood. In order to elucidate the mechanism and nature of blunt head trauma from such falls, we have investigated the possible correlation between patterns of skull fractures and the dynamics inducing these injuries. In a 10-year survey of pediatric medicolegal autopsies conducted at the L. Greenberg Institute of Forensic Medicine in Tel Aviv, Israel, we have observed that all victims of alleged falls from low heights exhibited unilateral skull fractures. Only in four instances were bilateral temporoparietal fractures detected. Thorough investigation into the circumstances surrounding these four incidents, along with the evaluation of the forces exerted upon the cranium at the time of impact, suggest that symmetrical cranial fractures in infants are most likely the result of bilateral compression of the head between two surfaces, rather than the result of a localized impact.