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Skull fractures in abusive head trauma: a single centre experience and review of the literature

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Abstract

Purpose

The authors provide a comprehensive framework with which to approach paediatric calvarial injury sustained as a result of suspected abusive head trauma (AHT). This is achieved through the presentation of a case series set in the context of the unique morphology of the infant skull and the possible diagnostic pitfalls which may arise due to the presence of variant anatomy or other mimicking conditions.

Methods

A retrospective analysis of sixty-three patients referred to our institution with suspected AHT was carried out. Seventeen patients with skull fractures were identified and their fractures were described in terms of anatomical location, type and course. Our data was then interpreted in the light of known anatomical fracture mimics and the available literature on the subject.

Results

Forty-two skull fractures were identified and described in our cohort, most of which were simple linear fractures of the parietal bones (33%). There were also a substantial number of complex stellate fractures, namely of the parietal (29%) and occipital (10%) bones. Eleven fracture mimics including accessory sutures and wormian bones were also identified in this cohort.

Conclusions

Our study supports and builds on the existing literature, thereby offering a more complete view of the spectrum of calvarial damage sustained as a result of AHT in the context of its diagnostic pitfalls.

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Data availability

Data is available from the corresponding author upon reasonable request.

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Author information

Authors and Affiliations

  1. University College London Medical School, London, UK

    Jai Sidpra

  2. Department of Neurosurgery, Great Ormond Street Hospital for Children, London, UK

    Noor ul Owase Jeelani

  3. Department of Craniofacial Surgery, Great Ormond Street Hospital for Children, London, UK

    Juling Ong

  4. Division of Biosciences, University College London, London, UK

    Wendy Birch

  5. Department of Radiology, Great Ormond Street Hospital for Children, London, UK

    Kshitij Mankad

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  1. Jai Sidpra
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  2. Noor ul Owase Jeelani
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  3. Juling Ong
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  4. Wendy Birch
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  5. Kshitij Mankad
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Correspondence to Kshitij Mankad.

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This clinical audit was approved by the institutional review board (reference number 2780).

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Sidpra, J., Jeelani, N.u.O., Ong, J. et al. Skull fractures in abusive head trauma: a single centre experience and review of the literature. Childs Nerv Syst 37, 919–929 (2021). https://doi.org/10.1007/s00381-020-04870-6

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  • DOI: https://doi.org/10.1007/s00381-020-04870-6

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