Radiological Atlas of Child Abuse

A Complete Resource for MCQs, v. 1

Amaka Offiah, Christine Hall

• Publisher: CRC Press
• Year: 2018
• ISBN:
  9781315347523
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

The radiological abnormalities associated with suspected child abuse can be extremely subtle. If missed, a baby or child may be returned to an environment where episodes of abuse may escalate. Similarly, a wrongful diagnosis can lead to an infant being removed from loving carers. This atlas will be of particular use to radiologists (both in training and at consultant level), and also to other doctors who may be first in line to encounter suspected abuse, including paediatricians, accident and emergency doctors, orthopaedic surgeons and pathologists. It uses numerous radiographs from Professor Hall's collection amassed over three decades, including many examples of the sorts of difficult cases and normal variants that are found in day to day practice. It offers assistance with the initial interpretation of what are often difficult and subtle findings in the emotionally charged environment that frequently exists when child abuse is suspected.

SECTION B

Skeletal injuries in child abuse

I Axial skeleton

CHAPTER 2

Skull

Skull fractures result from a direct impact of the head against a hard object or surface. Accidental falls under the force of gravity will result in the infant’s head, because of its disproportionately large size and weight, impacting the floor first. In infants there needs to be a history of an accident of sufficient magnitude to account for a fracture. The vast majority of domestic falls of up to five feet, solely under the force of gravity do not result in a skull fracture. Rare cases are reported of fractures occurring from low falls. Any force added to the force of gravity increases the likelihood of a fracture occurring. For example this may occur when a carer falls while carrying the infant. In this situation there is the height of the fall (gravity) together with the forward momentum and propulsive force exerted by the adult.

PATTERNS OF SKULL FRACTURES

–A linear, hairline, unilateral parietal fracture is the commonest type of skull fracture seen either as a result of accidental or abusive trauma.

–Other fracture types indicate that forces have occurred that are greater than those generated following a simple fall. They may be more suggestive of abusive physical trauma but need to be put into the context of the history.

•A fracture crossing a suture line (more than one skull bone fractured). Fractures may travel along the sutures for a short distance and therefore a single impact may result in discontinuous fractures across a suture affecting two bones. Sometimes symmetrical fractures may be present affecting both parietal bones, but not crossing or involving the sagittal suture. These may be the result of two separate impacts, with a higher specificity for abuse, or the result of a single crushing force applied simultaneously to both sides of the head (for example standing on the head of the infant).

•Wide fractures are those equal to or greater than 4 mm in width measured on the skull radiographs, NOT from CT images of the head.

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Table of contents

• Cover Page
• Half Title
• Title Page
• Copyright Page
• Contents
• Foreword
• Preface
• About the authors
• Acknowledgement
• SECTION A Image production, display and interpretation in child abuse
• SECTION B Skeletal injuries in child abuse
• VI References
• Index