Re L and M (Children) [2013] EWHC 1569 (Fam)

Skull fracture. Basilar skull fracture ; Depressed skull fracture ; Linear skull fracture Skull fractures may occur with head injuries. The skull provides good protection for the brain. However, a severe impact Infant skull fracture image. Although the skull is both tough and resilient and provides excellent Anisotropic composite human skull model and skull fracture validation against temporo-parietal skull fracture. A composite material model for skull , taking into account damage is implemented in the Strasbourg University finite element head model SUFEHM in order to enhance the existing skull mechanical constitutive law.

Skull fracture

Differences in types of artificial cranial deformation are related to differences in frequencies of cranial and oral health markers in pre-Columbian skulls from Peru. Museu de Arqueologia e Etnologia. Artificial cranial deformation is a cultural practice that modifies the shape of the skull during the early infancy.

Which features of intra-cranial injury in children can be accurately dated on the basis of computed tomography (CT) and MRI differences?

To support our nonprofit science journalism, please make a tax-deductible gift today. This unfortunate individual, who lived in Peru between and B. Cranial surgery without modern anesthesia and antibiotics may sound like a death sentence. But trepanation—the act of drilling, cutting, or scraping a hole in the skull for medical reasons—was practiced for thousands of years from ancient Greece to pre-Columbian Peru.

Not every patient survived. But many did, including more than subjects of the Inca Empire. After a traumatic injury, such surgery would have cleaned up skull fractures and relieved pressure on the brain, which commonly swells and accumulates fluid after a blow to the head. Trepanned skulls have been found all over the world, but Peru, with its dry climate and excellent preservation conditions, boasts hundreds of them. If the bone around the surgical hole showed no signs of healing, the researchers knew the patient died either during or very shortly after the surgery.

Detecting physical abuse in children: Imaging and reporting considerations for radiologists

Bilateral skull fractures in infancy may result from accidental or abusive injury. Consultation with a child abuse pediatrician may assist with determining the likelihood of accident or abuse. Diagnostic considerations for the infant with bilateral skull fractures are reviewed, including single impact, double impact, and compression mechanisms of injury, as well as the possibility of accessory sutures as skull fracture mimics.

Illustrative cases exemplify the evaluative process, including obtaining a detailed history, assessing for the presence or absence of additional physical or radiographic signs of injury, screening for psychosoical risk, and obtaining three-dimensional reconstruction of CT bone images. An understanding of plausible mechanisms of injury that can result in bilateral skull fractures in infancy can assist with making an accurate determination of likelihood of accident or abuse.

Skull fractures in infancy are common in both accidental trauma and inflicted injury.

A specimen of a skull showing a linear fractures of the frontal and right Dating of injury: The victim should have died immediately after sus- taining head injury.

Radiologists may be the first clinical staff to suspect non-accidental injuries when confronted with a particular injury pattern. Knowledge of these is essential if the opportunity to save a child from future neglect is not to be missed. At the same time, it is essential that suspicion is not raised inappropriately as the consequences for an innocent but accused parent or guardian are significant. Over recent years, there have been a number of titles given to the constellation of injuries that are the result of the physical abuse of children.

A skeletal survey is performed in cases of suspected abuse to assess and document the extent of skeletal injuries. Lead markers should be used in skeletal surveys and some institutions will repeat radiographs that do not have a lead marker within the primary field. Bone scans are performed in some institutions because of their ability to detect radiographically-occult fractures.

A number of fractures have been recognized as highly specific to non-accidental injuries rather than accidental injury. They include:. It is the most sensitive in detecting fractures of rib, scapula, spine, diaphysis and pelvis. The test becomes positive few hours after injury. Normally there is high uptake in the epiphyses of bones which should not be confused with a fracture 9. The ability to date injuries is critical for medicolegal purposes and thus must be done carefully please refer to specialist text for specific guidelines.

Traumatic periosteal injury can be seen up to 7 days post-injury and therefore can be used for dating.

Skull Fractures

Where a skull fracture is identified in a child, there will be concerns about how it has been caused and whether it was a result of non-accidental injury. If a non-accidental injury is suspected within care proceedings, often a medical expert neuroradiologist will be instructed to consider the injury and any explanations for it. I hope the following may explain a little about the skull and skull fractures. As the largest bone, the parietal bone is the most likely bone to fracture in an accident.

Subsequently, suspicion often arises if it is one of the other bones that has fractured.

(4) Skull fractures do not heal by callus formation and so dating of an injury is especially difficult. If the edges are round and smooth it is likely to be more than two.

Know more. This judgment was delivered in private. The judge has given leave for it to be reported on the strict understanding that irrespective of what is contained in the judgment in any report no person other than the advocates and any other persons identified by name in the judgment itself may be identified by name and that in particular the anonymity of the children, the adult members of their family and their location must be strictly preserved.

A local authority applies to the court for care orders in respect of two children, W aged 2 and B aged 8 months. The case comes before me for a finding of fact hearing. On 3rd December B was taken to the X Hospital. CT head scans disclosed that he had sustained bilateral parietal skull fractures with overlying soft tissue swelling.

Initially the local authority sought a finding that the injuries were non-accidental injuries caused by one or other of the parents. On the morning of the first day of this hearing, having reviewed the evidence, the local authority served a re-amended schedule of findings sought. The local authority now seeks a finding that the injuries were inflicted by the father. The father accepts that the injuries were sustained at a time when the children were in his sole care.

He accepts that the mother bears no responsibility.

A home for paediatricians. A voice for children and youth.

Six-year-old Ellie Butler suffered skull fractures twice in her tragically short life – the first possibly dating back to when her father was accused of assaulting her as a baby, a court has heard. The child was allegedly battered to death by Ben Butler in October , just 11 months after he won a legal battle to get her back after she was taken into care. The Old Bailey trial has heard how Butler, 36, was convicted of hurting Ellie in when she was six weeks old but was later cleared on appeal.

On the day of her death, jobless Butler was alone with Ellie and another child while her mother Jennie Gray, 36, was at work as a graphic designer in the City of London.

Radiographs of the spine, skull, hands and feet should be obtained as well.2 Dating of fractures is important when abuse is suspected, as the.

Long-time readers will have been enjoying the regular frank exchange of views and pleasantries between Mostyn J and the Court of Appeal, but this is a new one. Thus, it is clear that in all civil proceedings P cannot be set higher than a scintilla above 0. The requirement of evidential clarity is quite distinct from an elevation of the probability standard.

This would be absurd and perverse. The second reason is that the dictum can only apply when all relevant facts are known, so that all possible explanations, except a single extremely improbable one, can properly be eliminated. A case based on circumstantial evidence depends for its cogency on the combination of relevant circumstances and the likelihood or unlikelihood of coincidence. A party advancing it argues that the circumstances can only or most probably be accounted for by the explanation which it suggests.

Consideration of such a case necessarily involves looking at the whole picture, including what gaps there are in the evidence, whether the individual factors relied upon are in themselves properly established, what factors may point away from the suggested explanation and what other explanation might fit the circumstances.

So at the end of any such systematic analysis, the court has to stand back and ask itself the ultimate question whether it is satisfied that the suggested explanation is more likely than not to be true.

Jacksonville man jailed in abuse of 5-week-old baby

Jeffrey Linzer Sr. This article is adapted from one that originally appeared in the July issue of Pediatric Emergency Medicine Reports. According to one study, as many as one in five children seen in the emergency department ED may be missed cases of physical abuse; thus, emergency physicians have a responsibility to consider abuse in the differential of every injured child.

Physical abuse is most simply defined as injury inflicted on a child by a caregiver. The identification of child abuse requires the completion of a medical and social evaluation, and should be followed by the notification of child protective services CPS.

Basilar skull fracture; Depressed skull fracture; Linear skull fracture. Considerations. Skull fractures may occur with head injuries. Review Date: 9/​23/

Skull fractures can lead to an early death, even if the victims initially survived the injuries, according to a new study that looked at skulls from three Danish cemeteries with funeral plots dating from the 12th to the 17th centuries. This is the first time that researchers have used historical skulls to estimate the risk of early death among men who survived skull fractures , experts said.

The study showed that these men were 6. Today, the risk of dying after getting a traumatic brain injury is about half that, likely because of improvements in modern medicine and social support, according to the researchers. Often, epidemiology — the study of disease incidence and prevalence among large populations — is confined to living samples. But the researchers suggest that skull fractures, much like high blood pressure or cholesterol in present-day patients, can be used in historic samples as markers for an increased risk of getting sick or dying.

Imaging in Child Abuse

All rights reserved. King Tut probably died from a broken leg, scientists say, possibly closing one of history’s most famous cold cases. A CT scan of King Tutankhamun’s mummy has disproved a popular theory that the Egyptian pharaoh was murdered by a blow to the head more than 3, years ago. Instead the most likely explanation for the boy king’s death at 19 is a thigh fracture that became infected and ultimately fatal, according to an international team of scientists.

Skull fractures and intra-cranial pathology. Differential diagnosis of accidental and non-accidental skull fractures. Growing skull fractures. Dating skull fractures.

E-book mobile version. Index of Core Concept Chapters. About Core Concepts. Non-Accidental Musculoskeletal Injuries. I n a clinical setting where musculoskeletal injury is the chief complaint, it is imperative to maintain a threshold of suspicion for physical abuse as the primary cause of an injury. Non-accidental injuries may be difficult to recognize since caretakers rarely disclose maltreatment, some children cannot provide a history, and signs and symptoms of physical abuse may be subtle or confused with other common pediatric diagnoses.

Corner fracture, also known as bucket handle fracture, is a metaphyseal fracture that is pathognomonic of non-accidental trauma.

Basilar Skull Fracture


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