Aims To describe whether haemorrhage into the fracture gap, bone marrow, or periosteum, and loss of osteocyte nuclei from infant rib fracture margins, are true markers of vitality or may be seen solely as a consequence of cardiopulmonary resuscitation attempts. Methods and results A description is provided of histological findings in sampled rib fractures in a retrospective consecutive series of infants, aged 1 month to 1 year, who suffered sudden death. All had undergone cardiopulmonary resuscitation (CPR) and were investigated by use of skeletal survey, whole body computed tomography (CT), and invasive postmortem (PM). There was no suspicion of child abuse. 15 infants were studied, 9 of whom had anterior/anterolateral rib fractures; slides were available with consent for use in seven. Skeletal survey identified no fractures. CT and PM showed 46 fractures, 27 of which were examined histologically. Marrow cavity haemorrhage> 2 mm in diameter was seen in 55% of fractures; easily identifiable red cells were seen in the fracture gap in 36%, and beneath the periosteum in 36%. Loss of intact osteocytes from lacunae in bone fragments at the fracture margins relative to distant areas was obvious in 50% of fractures. Conclusions Anterior rib fractures, visible on CT and histologically, are common after CPR in infants. Empty lacunae and bleeding into the fracture gap, into the marrow cavity and beneath the periosteum are all frequent in CPR‐related infant rib fractures, and should not be used to discriminate between true in‐vivo injury and perimortem injury.

This paper describes the development of a specialist forensic post-mortem room, complete with digital imaging facilities, by the Institute of Forensic Medicine at the University Hospital of Wales, Cardiff. It gives the background to the development of the facility, and briefly details the specifications before discussing the use of digital imaging in evidence and the need for a full-time specialist forensic medical photographer.

BackgroundDespite public inquiries, and some changes to legislation following high-profile multiple homicides that were not detected by autopsy, coroners continue to rely largely on the autopsy. Regardless of the extent of quality failings and excess deaths at some hospitals, not detected through the coroner system, the autopsy is scarcely used by hospitals to monitor standards and educate.ObjectiveTo explore when a compulsory medicolegal autopsy should, and should not, be used.MethodTwo hundred and thirty-six cases referred to a senior coroner were evaluated by pathologists with long experience of forensic, coronial and hospital autopsies, using detailed antecedent medical and circumstantial information: after their advice, the senior coroner decided what kind of autopsy provided sufficient information for his purposes.ResultsIn nearly 40% (n=88) of deaths where the senior coroner accepted jurisdiction, issues raised could be resolved through analysis of medical records and antecedent information, supplemented only by detailed external examination of the body.ConclusionsTimely provision of sufficient information allows informed decisions about the requirement for, and nature and extent of, medical investigations into a death: unnecessary post mortem dissection is avoided, protecting the rights, under Articles 8 and 9 of the Human Rights Act 1998, of the bereaved to privacy, family life and religious practice. Although improvements in healthcare can undoubtedly result from detailed coroners’ inquiries, those deaths where the matters investigated relate only to the accuracy of a natural cause of death or sit with a healthcare provider’s internal quality assurance, should be investigated by the healthcare system in collaboration with the bereaved.