Bilateral Parietal Skull Fractures in Infants Attributable to Accidental Falls

Alsahlawi, Aysha; Morantz, Gillian; Lacroix, Caroline; Saint‐Martin, Christine; Dudley, Roy

doi:10.1159/000516972

Cited by 5 publications

(8 citation statements)

References 33 publications

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“…Múltiplas fraturas e em diferentes estágios de cicatrização levantam a hipótese de lesão intencional na ausência de doenças imunológicas e metabólicas. 19,20 Brazilian Journal of Health Review, Curitiba, v. 5, n. 6, p. 22624-22629, nov./dec., 2022…”

Section: Discussionunclassified

Violência física infantil: correlação radiológico-clínica

Conceição¹,

Neves²,

Maldonado³

et al. 2022

Braz. J. Hea. Rev.

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A violência física infantil é uma causa de morbimortalidade significativa nessa faixa etária. Ferimentos em partes moles e fraturas são comuns nos maus-tratos. A finalidade do atual estudo se baseia em uma revisão da literatura abordando os tipos mais comuns de agravos decorrentes de lesões intencionais. Os profissionais da área assistencial devem identificar lesões características de agressão, e portanto, auxiliar na proposta terapêutica.

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Section: Discussionunclassified

Violência física infantil: correlação radiológico-clínica

Conceição¹,

Neves²,

Maldonado³

et al. 2022

Braz. J. Hea. Rev.

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“…Although often suspicious for abuse, some literature supports that complex skull fractures, including bilateral fractures, can occur accidentally, [7][8][9] even from a single impact event. [10][11][12] Literature from the field of forensic pathology describes the pliable nature of the infant skull supporting the possibility of a skull fracture resulting from direct or indirect force-with inbending of the skull at the point of impact and outbending of the adjacent site. 9,13,14 A review of bilateral skull fractures in infancy proposed 3 general mechanisms of injury, including single impact, double impact, and compression mechanisms.…”

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confidence: 99%

“…Even when a mechanism is presented on history, bilateral skull fractures may still raise suspicion for abuse because of limited understanding of these injuries leading to question of plausibility for nonwitnessed events. In a recent study of witnessed accidental cases, the series was limited to 3 cases, which included a fall from the father's arms on stairs from a height of 121 cm, a similar height fall from a sibling's arms, and a fall from a changing table 12 …”

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confidence: 99%

“…9,16 Only a few in vivo case reports exist in the literature describing bilateral skull fractures, caused by falls and crush/compression. These include accidental single impact falls to the vertex or midline posterior occiput, [10][11][12]17 double impact including 2 separate events or stair falls, 12,15,18 dog bite crush injury, 19 compression of the head between two unyielding surfaces, 20 and confession of abusive compression of the head with hands and arms. 21 Even when a mechanism is presented on history, bilateral skull fractures may still raise suspicion for abuse because of limited understanding of these injuries leading to question of plausibility for nonwitnessed events.…”

mentioning

confidence: 99%

“…In a recent study of witnessed accidental cases, the series was limited to 3 cases, which included a fall from the father's arms on stairs from a height of 121 cm, a similar height fall from a sibling's arms, and a fall from a changing table. 12 A thorough understanding of bilateral skull fractures is crucial to prevent over-calling abuse or mistaking inflicted injury as accidental. Given the paucity of empiric data on bilateral skull fractures in infancy, this retrospective case review sought to describe characteristics of bilateral skull fractures in infancy for a large sample involving child abuse hospital consultation to determine accident versus abuse.…”

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confidence: 99%

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Understanding Bilateral Skull Fractures in Infancy

et al. 2022

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BackgroundBilateral skull fractures in infancy often raise suspicion for abuse. Nevertheless, literature suggests that they may occur accidentally. However, empiric data are lacking.ObjectiveThis multicenter retrospective review aimed to characterize bilateral skull fractures in a large sample.Participants and SettingMedical records for infants younger than 24 months with bilateral skull fractures involving hospital consultation with a child abuse pediatrician (CAP) were reviewed from 2005 to 2020 at 13 nationally represented institutions.MethodsStandardized data collection across institutions included historical features, fracture characteristics, and additional injuries, as well as the CAP's determination of accident versus abuse. Pooled data were analyzed for descriptive and bivariate analyses.ResultsFor 235 cases, 141 were accidental, and 94 abuse. The majority occurred in young infants, and a history of a fall was common in 70% of cases. More than 80% involved both parietal bones. Bilateral simple linear fractures were more common in accidental cases, 79% versus 35%, whereas a complex fracture was more frequent in abuse cases, 55% versus 21% (P < 0.001). Almost two thirds of accidental cases showed approximation of the fractures at the sagittal suture, compared with one third of abuse cases (P < 0.001). Whereas focal intracranial hemorrhage was seen in 43% of all cases, diffuse intracranial hemorrhage was seen more in abuse cases (45%) than accidents (11%). Skin trauma was more common in abusive than accidental injury (67% vs 17%, P < 0.001), as were additional fractures on skeletal survey (49% vs 3%, P < 0.001).ConclusionsA fall history was common in bilateral skull fractures deemed accidental by a CAP. Most accidental cases involved young infants with biparietal simple linear fractures, without skin trauma or additional fractures. A skeletal survey may aid in the determination of accidental or abusive injury for unwitnessed events resulting in bilateral skull fractures in infants.

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