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Pediatric skull fractures: could suture contact be a sign of abuse?

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Abstract

Purpose

Skull fractures in infants and young children can occur as a result of both accidental trauma and abuse. 1/3 of children with abuse-related head trauma and 1/5 of children with abuse-related fractures were overlooked during the initial evaluation. In this study, we aim to investigate the prevalence of skull fractures that come into contact with the suture in head traumas caused by accidents and abuse, and also to see if contact of the fracture line with the suture could be used as a sign for abuse in the pediatric population.

Methods

Forry-four patients with head trauma were retrospectively assessed between January 2010 and June 2020 and were confirmed to have fractures on a brain CT. Patient age, gender, and head injury type were recorded. The fracture site, location and number, the contact of the fracture line with the suture, the name, and number of the suture it came into contact with were determined.

Results

Twenty-eight skull fractures in 22 children with a diagnosis of child abuse and 25 skull fractures in 22 children due to accidental trauma were evaluated in the same age and gender range. Eighteen (64%) of 28 abuse-related skull fractures were in contact with two or more sutures. Two (8%) of 25 accident-related fractures were related to two or more sutures. Abuse-related fractures had a significantly higher suture contact rate than accident-related fractures (p = 0.007).

Conclusion

Contact with two or more sutures of a skull fracture is a finding related to abuse rather than accident.

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Availability of data and material

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Radiology, Dr. Sami Ulus Training and Research Hospital, Ankara, Turkey

    Berna Uçan

  2. Department of Radiology, Ankara Training and Research Hospital, Ankara, Turkey

    Oğuzhan Tokur

  3. Department of Radiology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey

    Sonay Aydın

Authors
  1. Berna Uçan
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  2. Oğuzhan Tokur
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  3. Sonay Aydın
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Berna Uçan and Sonay Aydın. The first draft of the manuscript was written by Oğuzhan Tokur and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Oğuzhan Tokur.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Erzincan Binali Yildirim University (11.09.2021-Ebyu/Kaek).

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Written consent to publish this information was obtained from the study participant.

Conflict of interest

The authors declare that they have no conflict of interest.

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Uçan, B., Tokur, O. & Aydın, S. Pediatric skull fractures: could suture contact be a sign of abuse?. Emerg Radiol 29, 403–408 (2022). https://doi.org/10.1007/s10140-022-02024-6

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  • DOI: https://doi.org/10.1007/s10140-022-02024-6

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