Skeletal Atlas of Child Abuse

Abstract

), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights.Printed on acid-free paper Humana Press is part of Springer Science+Business Media (www.springer.com) We dedicate this atlas to our spouses, whose support enabled us to be successful in this endeavor. ForewordChild abuse investigation is one of the most contentious areas of forensic pathology. The forensic pathologist must determine, within a reasonable degree of medical certainty, the cause and manner of death. This opinion must be rendered with a comprehensive knowledge of the case -a knowledge that includes the medical history, scene findings, police investigation, history of terminal events, and a complete autopsy. The autopsy is one component of the overall investigation, and it is imperative that all injuries be thoroughly documented. Although other pathologists may offer alternative opinions regarding the mechanism of injury, or even the cause of death, the actual anatomic findings should never be in question. The collaborative approach taken at the Harris County Institute of Forensic Sciences (HCIFS) reflects this philosophy. The team of forensic anthropologists who work within the office and alongside the pathologists is immeasurably important in completing the requisite documentation. In our experience, anthropologists bring to the autopsy table another dimension of knowledge that is rarely tapped in the medical examiner setting. In this collaborative setting, suspected child abuse deaths are first examined by a forensic pathologist, with complete documentation of soft tissue injuries including visceral injuries, neuropathology, and examination of subcutaneous tissues. A forensic anthropologist is then brought in with the pathologist to take the examination another step, exposing all skeletal elements. The need for additional studies of the exposed elements (including histology and further anthropologic processing) is determined at that time. In this approach, the traditional role of the forensic anthropologist (examination of skeletal remains) is greatly expanded while keeping within the scope of his or her expertise.The value of the collaborative approach between forensic pathologists and anthropologists is perhaps best illustrated by the numerous examples of classic metaphyseal lesions presented in this text. These lesions are difficult -and sometimes impossible -to identify radiographically. They must be sought at autopsy. Only with careful analysis of many cases using the approach described in this text (including abusive injuries, accidental injuries, and deaths from disease) will the t...

Alagille syndrome case report: implications for forensic pathology and anthropology

“…This evidences how important it is to relate the features of a fracture (location, type, force required) to the described mechanism of injury, as well as to the peculiarities of the underlying disease. Literature sources often report on cases where children suffering from consequences of biliary atresia or other infrequent pathologies have been confused with maltreated children, since the pathophysiological background of the disease and the natural susceptibility to fractures was not taken into consideration [16,20]. Although rare, Alagille syndrome is a condition that should be known to forensic medicine practitioners and whose features and peculiarities must be taken into consideration in pediatric autopsy and suspected cases of child abuse.…”

“…In our case, the features of the fracture (linear fracture of the temporal bone at the level of the hat brim line) are in line with low-energytransfer forces [20] and with injuries that commonly occur from falls (impact to the side of the head) [30][31][32][33], making it less suspicious of inflicted trauma. Namely, although linear head fractures were once believed to be possible evidence of inflicted trauma [23] and indeed can be often found in victims of child abuse [29,18], today, there is agreement that complex fractures (stellate, intersecting, and crossing suture fractures) primarily of the parietal bones and the occipital bone represent more corroborative evidence of inflicted injuries [20]. The temporal bone itself is not commonly fractured in children [20], but its fracturing is often linked to falls [30][31][32][33] and its thinness makes it more susceptible to fractures than other bones.…”

“…Namely, although linear head fractures were once believed to be possible evidence of inflicted trauma [23] and indeed can be often found in victims of child abuse [29,18], today, there is agreement that complex fractures (stellate, intersecting, and crossing suture fractures) primarily of the parietal bones and the occipital bone represent more corroborative evidence of inflicted injuries [20]. The temporal bone itself is not commonly fractured in children [20], but its fracturing is often linked to falls [30][31][32][33] and its thinness makes it more susceptible to fractures than other bones. In the presented case, the bone in question appeared even thinner and less mineralized than expected for a child of that age, which could explain the disproportionate relationship between the injury and the low force of the fall.…”

“…Among them, head injuries occupy a significant place since the craniofacial regions have been recognized as the most frequently injured area in child maltreatment cases [19]. Head injuries represent the most common cause of death in abused children [20] (as an isolated finding or in combination with other injuries), but also a common type of accidental trauma in children. Given that the 95 % of severe head injuries are attributed to child abuse [21], this type of injuries in children should be analyzed and interpreted carefully [22][23][24][25][26].…”

Novel Classification System of Rib Fractures Observed in Infants

“…Diagram of the four regions of the rib. The illustration is reprinted with kind permission of S pringer S cience+ B usiness M edia .…”