Rowbotham Samantha K, Blumenthal Ryan, Delabarde Tania, Legrand Laurence, van der Walt Elizabeth, Sutherland Tom, Lockhat Zarina, Arthurs Owen J
Victorian Institute of Forensic Medicine, 65 Kavanagh St, Southbank, Victoria 3006, Australia; Department of Forensic Medicine, Monash University, 65 Kavanagh St, Southbank, Victoria 3006, Australia.
Department of Forensic Medicine, University of Pretoria, Pathology Building, 5 Bophelo Rd, Prinshof Campus, 0084, South Africa.
Forensic Sci Int. 2021 Jun;323:110788. doi: 10.1016/j.forsciint.2021.110788. Epub 2021 Apr 20.
In cases where a deceased child exhibits trauma as a result of a physical abuse blunt impact load, a parent/caregiver may provide a simple short fall (SSF) as the justification for that trauma. The skeletal fractures remain difficult to differentiate between a SSF and physical abuse however, as both are the result of a blunt impact load, and are therefore biomechanically alike, and the rare nature of these fatalities means only anecdotal research has been available to validate such claims. The aim of this pilot study was to investigate if there may be differences in the skeletal fracture patterns and types resulting from SSFs compared with those resulting from physical abuse blunt impacts. Paediatric (<10 years) cases of fatal SSFs (≤1.5 m) and physical abuse were collected from the Victorian Institute of Forensic Medicine (Australia), Institut Médico-Légal de Paris (France), University of Pretoria (South Africa) and Great Ormond Street Hospital (England). For each case the intrinsic and extrinsic variables were recorded from medico-legal reports and skeletal trauma was documented using post-mortem computed tomography scans and/or skeletal surveys. Three SSFs and 18 physical abuse cases were identified. Of the SSF cases, two exhibited fractures; both of which were simple linear neurocranial fractures. Comparatively, 12 of the physical abuse cases exhibited fractures and these were distributed across the skeleton; 58% located only in the skull, 17% only in the post-cranial and 25% located in both. Skull fracture types were single linear, multiple linear and comminuted. This pilot study suggests, anecdotally, there may be differences in the fracture patterns and types between blunt impact loads resulting from a SSF and physical abuse. This data will form the foundation of the Registry of Paediatric Fatal Fractures (RPFF) which, with further multicentre contributions, would allow this finding to be validated.
在一些案例中，死亡儿童因身体虐待钝器撞击负荷而出现创伤，父母/照顾者可能会称这是一次简单的短距离跌落（SSF）造成的创伤。然而，骨骼骨折仍难以区分是由SSF还是身体虐待导致的，因为两者都是钝器撞击负荷的结果，因此在生物力学上相似，而且这些死亡案例非常罕见，这意味着只有轶事性研究可用于验证此类说法。这项初步研究的目的是调查与身体虐待钝器撞击相比，SSF导致的骨骼骨折模式和类型是否可能存在差异。从澳大利亚维多利亚法医研究所、法国巴黎医学法律研究所、南非比勒陀利亚大学和英国大奥蒙德街医院收集了10岁以下儿童因致命SSF（≤1.5米）和身体虐待导致的案例。对于每个案例，从法医报告中记录内在和外在变量，并使用死后计算机断层扫描和/或骨骼检查记录骨骼创伤情况。共识别出3例SSF案例和18例身体虐待案例。在SSF案例中，有2例出现骨折；均为简单的线性颅骨骨折。相比之下，12例身体虐待案例出现骨折，且分布在全身骨骼；58%仅位于颅骨，17%仅位于颅后，25%位于两者。颅骨骨折类型为单一线性、多线性和粉碎性。这项初步研究轶事性地表明，SSF导致的钝器撞击负荷与身体虐待导致的钝器撞击负荷在骨折模式和类型上可能存在差异。这些数据将构成儿科致命骨折登记处（RPFF）的基础，随着更多多中心数据的贡献，这一发现将得到验证。
