Klotzbach H, Delling G, Richter E, Sperhake J P, Püschel K
Institute of Legal Medicine, University Hospital Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Germany.
Int J Legal Med. 2003 Apr;117(2):82-9. doi: 10.1007/s00414-002-0338-3. Epub 2002 Oct 31.
Detection and dating of infants' fractures plays an important role in the diagnosis of the battered child syndrome. Under this aspect three cases of infants with multiple fractures of different ages due to child abuse were evaluated post-mortem. Radiological findings were compared with the autopsy results, followed by contact radiography and histopathological assessment. Out of a total of 44 osseous lesions, 27 fractures were diagnosed by post-mortem skeletal survey, additionally 5 recent rib fractures were suspected, 4 of which were confirmed histologically and all were located paravertebrally. The fractures not detected radiologically were mostly recent rib fractures diagnosed or suspected at autopsy or by contact radiography and confirmed histologically. The histological investigation allowed a more precise dating of the fractures, particularly with reference to the early stages of fracture healing. Microscopic signs of fracture healing processes, such as periosteal thickening, osteoid production and calcification of soft callus tissue, can be detected earlier and quantified more accurately. In advanced stages of healing the osseous apposition rate can be measured semiquantitatively up to a certain extent. A scheme involving a careful external investigation, skeletal survey, autopsy, contact radiography and histology has been proven useful for diagnosing and dating infants' fractures.
婴儿骨折的检测与确定时间在受虐儿童综合征的诊断中起着重要作用。在此方面，对3例因虐待儿童导致不同年龄多发骨折的婴儿进行了尸检评估。将放射学检查结果与尸检结果进行比较，随后进行接触式放射摄影和组织病理学评估。在总共44处骨病变中，通过尸检骨骼检查诊断出27处骨折，另外怀疑有5处近期肋骨骨折，其中4处经组织学证实，且均位于椎旁。放射学未检测到的骨折大多是在尸检或接触式放射摄影时诊断或怀疑的近期肋骨骨折，并经组织学证实。组织学研究能够更精确地确定骨折时间，尤其是在骨折愈合的早期阶段。骨折愈合过程的微观迹象，如骨膜增厚、类骨质生成和软骨痂组织钙化，可以更早地被检测到并更准确地量化。在愈合的晚期阶段，骨附着率在一定程度上可以进行半定量测量。一个包括仔细的外部检查、骨骼检查、尸检、接触式放射摄影和组织学的方案已被证明对诊断和确定婴儿骨折时间有用。
