Wessels Robyn M, Moodley Halvani
Department of Diagnostic Radiology, Faculty of Radiation Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa.
SA J Radiol. 2022 Feb 22;26(1):2311. doi: 10.4102/sajr.v26i1.2311. eCollection 2022.
In its severest form, non-accidental injury (NAI) in children is fatal. South Africa has been reported to have double the global average of child homicides. Autopsy is the main investigation in fatal NAI with post-mortem skeletal surveys (PMSS) playing an adjunctive role. Whilst fracture patterns associated with NAI in living patients have been established, this has not been investigated in PMSS in South Africa.
To determine the incidence and characteristics of fractures in suspected fatal NAI cases. To calculate the incidence of fractures according to high-, moderate- and low-specificity fracture locations for NAI.
A retrospective review of all PMSS performed between 01 January 2012 and 03 December 2018 was conducted at the Charlotte Maxeke Johannesburg Academic Hospital.
Of the 73 PMSS, 33 (45.2%) demonstrated fractures. No statistical significance in sex was found: 38 (52.1%) were male and 35 (47.9%) were female ( > 0.05). The mean age of those who sustained fractures was 28 months (standard deviation [s.d.]: 21 months). A total of 115 fractures were sustained, of that the top five bones fractured were the ribs 37 (32.2%), parietal bone 13 (11.3%), ulna 13 (11.3%), femur 13 (11.3%), and radius 11 (9.6%). High-specificity fracture locations accounted for 40/133 (30.1%).
The fracture types in PMSS were similar to those in live skeletal surveys. Our study's fracture rate was higher in comparison to international studies. The PMSS is a valuable adjunct to autopsy in detecting occult fractures of the limbs. We recommend that PMSS be performed in suspected fatal NAI cases at least in children up to 24 months of age.
儿童非意外性损伤（NAI）最严重的形式是致命的。据报道，南非儿童杀人案发生率是全球平均水平的两倍。尸检是致命性NAI的主要调查手段，死后骨骼检查（PMSS）起辅助作用。虽然已确定了活体患者中与NAI相关的骨折模式，但南非尚未在PMSS中对此进行研究。
确定疑似致命性NAI病例中骨折的发生率和特征。根据NAI的高、中、低特异性骨折部位计算骨折发生率。
对2012年1月1日至2018年12月3日在夏洛特·马克西克约翰内斯堡学术医院进行的所有PMSS进行回顾性研究。
在73例PMSS中，33例（45.2%）显示有骨折。未发现性别有统计学意义：男性38例（52.1%），女性35例（47.9%）（>0.05）。骨折患者的平均年龄为28个月（标准差[s.d.]：21个月）。共发生115处骨折，其中骨折最多的前五根骨头是肋骨37处（32.2%）、顶骨13处（11.3%）、尺骨13处（11.3%）、股骨13处（11.3%）和桡骨11处（9.6%）。高特异性骨折部位占40/133（30.1%）。
PMSS中的骨折类型与活体骨骼检查中的相似。与国际研究相比，我们研究中的骨折发生率更高。PMSS在检测四肢隐匿性骨折方面是尸检的重要辅助手段。我们建议至少对24个月以下的疑似致命性NAI儿童病例进行PMSS。
