Abstract
Examination of the skeletal system of the deceased child, particularly in cases where physical abuse may have occurred, is a critical part of the postmortem examination. Since some injuries, particularly metaphyseal injuries, would not be discernible with a traditional autopsy approach, radiographic imaging of the deceased child is critical. The presence of healing fractures in the setting of fatal visceral trauma may distinguish a single acute event from a pattern of inflicted injury (“battered child syndrome”). Though many pathologists may have little experience handling or interpreting bony injuries, most bony findings are readily removed at autopsy and can be decalcified and subjected to histological evaluation with very little investment in special techniques or tools. Correlation of the radiographic, gross, and microscopic findings is invaluable to the radiologist, pediatrician, and pathologist alike.
Keywords
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsBibliography
Barsness KA, Cha ES, Bensard DD, Calkins CM, Partrick DA, Karrer FM, Strain JD. The positive predictive value of rib fractures as an indicator of nonaccidental trauma in children. J Trauma. 2003;54:1107–10.
Bishop N, Sprigg A, Dalton A. Unexplained fractures in infancy: looking for fragile bones. Arch Dis Child. 2007;92:251–6.
Caffey J. Multiple fractures in the long bones of infants suffering from chronic subdural hematoma. Am J Roentgenol Radium Ther Nucl Med. 1946;56:163–73.
Caffey J. Some traumatic lesions in growing bones other than fractures and dislocations: clinical and radiological features. Br J Radiol. 1957;30:225–38.
Chapman T, Sugar N, Done S, Marasigan J, Wambold N, Feldman K. Fractures in infants and toddlers with rickets. Pediatr Radiol. 2010;40:1184–9.
Clouse JR, Lantz PE. Posterior rib fractures in infants associated with cardiopulmonary resuscitation [Abstract]. American Academy of Forensic Sciences; 2008.
Dolinak D. Rib fractures in infants due to cardiopulmonary resuscitation efforts. Am J Forensic Med Pathol. 2007;28:107–10.
Duval JV, Andrew TA. Two thumb method of infant CPR: is there an increased risk for posterior rib fractures? [Abstract]. National Association of Medical Examiners; 2007.
Halliday KE, Broderick NJ, Somers JM, Hawkes R. Dating fractures in infants. Clin Radiol. 2011;66:1049–54.
Horvai AE, Boyce BF. Metabolic bone diseases. Semin Diagn Pathol. 2011;28:13–25.
Hughes-Roberts Y, Arthurs OJ, Moss H, Set PAK. Postmortem skeletal surveys in suspected non-accidental injury. Clin Radiol. 2012;67:868–76.
Kleinman PK. Bony thoracic trauma. In: Kleinman PK, editor. Diagnostic imaging of child abuse. 2nd ed. St. Louis: Mosby; 1998.
Kleinman PK. Problems in the diagnosis of metaphyseal fractures. Pediatr Radiol. 2008;38 (Suppl 3):S388–94.
Kleinman PK. The spectrum of non-accidental Injuries (child abuse) and its imitators. In: Hodler J et al., editor. Musculoskeletal diseases 2009–2012. Diagnostic imaging 41th international diagnostic course in Davos (IDKD) Davos, March 29–April 3, 2009. Italy: Springer; 2009.
Kleinman PK, Marks Jr SC. A regional approach to the classic metaphyseal lesion in abused infants: the distal femur. Am J Roentgenol. 1998;170:43–7.
Kleinman PK, Schlesinger AE. Mechanical factors associated with posterior rib fractures: laboratory and case studies. Pediatr Radiol. 1997;27:87–91.
Kleinman PK, Marks SC, Blackbourne B. The metaphyseal lesion in abused infants: a radiologic-histopathologic study. Am J Roentgenol. 1986;146:895–905.
Kleinman PK, Marks SC, Adams VI, Blackbourne BD. Factors affecting visualization of posterior rib fractures in abused infants. Am J Roentgenol. 1988;150:635–8.
Kleinman PK, Marks Jr SC, Spevak MR, Belanger PL, Richmond JM. Extension of growth-plate cartilage into the metaphysis: a sign of healing fracture in abused infants. Am J Roentgenol. 1991;156:775–9.
Kleinman PK, Marks SC, Spevak MR, Richmond JM. Fractures of the rib head in abused infants. Radiology. 1992;185:119–23.
Kleinman PK, Marks Jr SC, Nimkin K, Rayder SM, Kessler SC. Rib fractures in 31 abused infants: postmortem radiologic-histopathologic study. Radiology. 1996;200:807–10.
Lonergan GJ, Baker AM, Morey MK, Boos SC. From the archives of the AFIP. Child abuse: radiologic-pathologic correlation. Radiographics. 2003;23:811–45.
Maguire S, Mann M, John N, Ellaway B, Sibert JR, Kemp AM, Welsh Child Protection Systematic Review Group. Does cardiopulmonary resuscitation cause rib fractures in children? A systematic review. Child Abuse Negl. 2006;30:739–51.
Marlow A, Pepin MG, Byers PH. Testing for osteogenesis imperfecta in cases of suspected non-accidental injury. J Med Genet. 2002;39:382–6.
Matshes EM, Lew EO. Two-handed cardiopulmonary resuscitation can cause rib fractures in infants. Am J Forensic Med Pathol. 2010;31:303–7.
McCarthy EF. Genetic diseases of bones and joints. Semin Diagn Pathol. 2011;28:26–36.
Mendelson KL. The Society for Pediatric Radiology ad hoc Committee on Child Abuse. Critical review of “temporary brittle bone disease”. Pediatr Radiol. 2007;35:1036–40.
Mendelson KL. The Society for Pediatric Radiology, the National Association of Medical Examiners. Post-mortem radiography in the evaluation of unexpected death in children less than 2 years of age whose death is suspicious for fatal abuse. Pediatr Radiol. 2004;34:675–7.
Miller ME. Temporary brittle bone disease: a true entity? Semin Perinatol. 1999;23(2):174–82.
Miller ME. The lesson of temporary brittle bone disease: all bones are not created equal. Bone. 2003;33:466–74.
Miller ME, Hangartner TN. Temporary brittle bone disease: association with decreased fetal movement and osteopenia. Calcif Tissue Int. 1999;64:137–43.
Rao P, Carty H. Non-accidental injury: review of the radiology. Clin Radiol. 1999;54:11–24.
Rauch F, Glorieux FH. Osteogenesis imperfecta. Lancet. 2004;363:1377–85.
Rauch F, Travers R, Parfitt AM, Glorieux FH. Static and dynamic bone histomorphometry in children with osteogenesis imperfecta. Bone. 2000;26(6):581–9.
Schilling S, Wood JN, Levine MA, Langdon D, Christian CW. Vitamin D status in abused and nonabused children younger than 2 years old with fractures. Pediatrics. 2011;127:835–41.
Sprigg A. Temporary brittle bone disease versus suspected non-accidental skeletal injury. Arch Dis Child. 2011;96(5):411–3.
Weber MA, Risdon RA, Offiah AC, Malone M, Sebire NJ. Rib fractures identified at post-mortem examination in sudden unexpected deaths in infancy (SUDI). Forensic Sci Int. 2009;189:75–81.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2014 Springer Science+Business Media New York
About this entry
Cite this entry
Baker, A.M. (2014). Evaluation of Pediatric Fractures at Autopsy. In: Collins, K., Byard, R. (eds) Forensic Pathology of Infancy and Childhood. Springer, New York, NY. https://doi.org/10.1007/978-1-61779-403-2_13
Download citation
DOI: https://doi.org/10.1007/978-1-61779-403-2_13
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-61779-402-5
Online ISBN: 978-1-61779-403-2
eBook Packages: Biomedical and Life SciencesReference Module Biomedical and Life Sciences