Forensic Aspects of Paediatric Fractures: Differentiating Accidental Trauma from Child Abuse

Description

This excellently illustrated book, now in a revised and extended second edition, not only describes the radiological findings which can be found in child abuse cases but also places them in a forensic perspective – a crucial aspect often underrepresented in radiological books. The aim is to enable physicians involved in non-accidental trauma cases to interpret radiological findings in light of the forensic circumstances under which these findings have arisen. Accordingly, the book will assist in determining whether a fracture is accidental or the result of abuse. Fractures are addressed not only by anatomical location but also by trauma mechanism, with careful attention to evidence regarding the reported mechanism and the clinical outcome. Drawing on the latest literature, the authors explain whether a particular form of trauma can cause a particular injury and identify where the reader can find the supporting evidence. The book will be essential reading and a superb reference for all who are involved in the diagnosis of child abuse, including pediatricians, emergency room physicians, and radiologists. It will also be a valuable resource for legal medicine physicians, lawyers, and judges. Foreword Contents 1: Child Abuse, Non-Accidental Trauma, and Inflicted Injuries 1.1 Defining Child Abuse 1.1.1 Child Abuse 1.1.2 Physical Abuse 1.1.3 Neglect 1.1.4 Emotional/Psychological Abuse 1.1.5 Sexual Abuse 1.1.6 Fabricated or Induced Illness by Parents/Caregivers 1.2 Epidemiology 1.3 Clinical Aspects 1.4 Defining Trauma and Injury 1.5 Cause of Injury 1.5.1 Introduction 1.5.2 Mechanical Trauma 1.5.2.1 Static Loading 1.5.2.2 Dynamic Loading 1.5.3 Non-mechanical Trauma: Physical Agents 1.5.4 Direct and Underlying Cause 1.6 Manner of Injury 1.7 Cutaneous Injuries 1.7.1 Introduction 1.7.2 Blunt-force Trauma: Closed Skin Injuries 1.7.2.1 Erythema 1.7.2.2 Bruises 1.7.2.3 Petechiae 1.7.3 Blunt-force Trauma: Open Injuries 1.7.3.1 Abrasions 1.7.3.2 Lacerations and Avulsions 1.7.3.3 Blunt Penetrating Trauma 1.7.4 Sharp-force Trauma 1.7.4.1 Incisions and Stab Wounds 1.7.4.2 Gunshot Wound 1.7.5 Non-mechanical Trauma: Near Contact with Physical Agents 1.8 Other Injuries 1.8.1 Introduction 1.8.2 Thoracoabdominal Injuries 1.8.2.1 Intrathoracic Injuries 1.8.2.2 Intra-abdominal Injuries 1.9 Objectifying Suspicions of Inflicted Injuries and Non-accidental Trauma 1.10 Characteristics of the Clinical History 1.10.1 Clinical History 1.10.2 The Origin of the Injuries 1.10.3 Delay in Seeking Medical Help 1.10.4 Attitude and Reaction of the Parents/Caregivers References 2: General Aspects of Fractures in Children 2.1 Introduction 2.1.1 Definition 2.1.2 Epidemiology 2.2 Diagnosis and Differential Diagnosis of Fractures in Children 2.2.1 Clinical Presentation 2.2.2 Differential Diagnosis 2.3 Fracture or Mimic 2.4 Fracture Description 2.4.1 Anatomic Location and Type of Bone 2.4.1.1 Identification of the Fractured Bone 2.4.1.2 Bone Type Long Bones Short Bones Flat Bones Sesamoid Bones Irregular Bones 2.4.1.3 Affected Part of the Bone 2.4.2 Type of Fracture and Direction of Fracture Lines 2.4.3 Position and Relationship of the Fracture Components 2.4.4 Complications 2.5 Cause of Fractures (Mechanism) 2.5.1 General Aspects 2.5.2 High-Energy Trauma 2.5.3 Low-Energy Trauma 2.5.3.1 Low-Energy Trauma: Normal Sufficient Bone—Single Load 2.5.3.2 Low-Energy Trauma: Normal Sufficient Bone—Repeated Load Avulsion Fractures Fatigue Fractures in Normal Bone: Stress Fractures 2.5.3.3 Low-Energy Trauma: Normal Insufficient Bone 2.5.3.4 Low-Energy Trauma: Abnormal Bone 2.5.3.5 The Use of Terms like Spontaneous and Pathological Fractures in Forensic Paediatrics 2.6 Manner of Fractures (Circumstances) 2.6.1 Intrauterine Fractures 2.6.1.1 Intrauterine Fractures in Normal Bone 2.6.1.2 Intrauterine Fractures in Weakened Bone 2.6.2 Fractures During Birth: Birth Trauma 2.6.2.1 General Aspects of Birth Trauma-Related Fractures 2.6.2.2 Incidence and Prevalence of Fractures Resulting from Birth 2.6.3 Fractures After Birth: Accidental Circumstances 2.6.4 Fractures After Birth: Non-Accidental Circumstances 2.6.4.1 Epidemiology 2.6.4.2 Specificity of Fractures, Sustained in Non-Accidental Circumstances 2.6.4.3 The Value of Haematomas in the Differential Diagnosis Between Accidental and Non-accidental Circumstances 2.6.4.4 Perpetrators and Victims 2.6.5 Fractures After Birth: Other Circumstances References 3: Radiology in Suspected Child Abuse 3.1 Introduction 3.2 Conventional Radiology 3.2.1 Guidelines 3.2.1.1 American College of Radiology 3.2.1.2 The Royal College of Radiologists and the Society and College of Radiographers 3.2.1.3 Examination on Indication 3.2.2 Adequacy of Examination 3.2.2.1 Number of Views 3.2.2.2 Technique 3.2.2.3 Technical Shortcomings in Making a Skeletal Survey 3.2.2.4 Follow-Up Skeletal Survey 3.3 Bone Scintigraphy 3.3.1 Effectivity of Bone Scintigraphy Versus Conventional Radiology 3.4 Computed Tomography 3.5 Linear Slot Scanning 3.6 Magnetic Resonance Imaging 3.7 Ultrasonography 3.8 Bone Densitometry 3.9 Post-Mortem Imaging 3.10 Radiation Dose in Imaging Suspected Child Abuse References Untitled 4: Fracture Dating 4.1 Introduction 4.2 Biology of Fracture Repair 4.2.1 Types of Fracture Repair 4.2.1.1 The Inflammatory Phase 4.2.1.2 The Reparative Phase 4.2.1.3 The Remodelling Phase 4.2.2 Factors that Influence Fracture Repair 4.2.2.1 Local Factors 4.2.2.2 Systemic Factors 4.3 Dating Fractures 4.3.1 Radiological Aspects of Fracture Dating 4.3.2 Histological Aspects of Fracture Dating 4.4 The Practice of Fracture Dating in Dutch Forensic Casework 4.4.1 Radiological Imaging Before and After Autopsy 4.4.2 Histological Analysis 4.4.3 Interpretation 4.4.4 Examples of Fracture Dating References 5: Head 5.1 General Aspects of Head Injuries 5.1.1 Introduction 5.1.2 Injuries to the Scalp and the Bony Tissues of the Skull 5.1.3 Injuries to the Orofacial Soft Tissues and the Intracranial Content 5.2 Injuries of the Scalp 5.2.1 Introduction 5.2.1.1 Anatomy of the Scalp 5.2.1.2 Scalp Injuries 5.2.1.3 Cause and Manner of Scalp Injuries 5.2.1.4 Type and Severity of Scalp Injuries 5.2.2 Cutaneous and Subcutaneous Injuries of the Scalp 5.2.2.1 Introduction 5.2.2.2 Bruises 5.2.2.3 Abrasions, Lacerations, and Avulsions General Aspects Trauma After Birth: Accidental Circumstances Trauma After Birth: Non-accidental Circumstances 5.2.2.4 Traction Alopecia 5.2.2.5 Scalp Injuries, Skull Fractures and Intracranial Injuries 5.2.3 Subgaleal Haematoma 5.2.3.1 Introduction 5.2.3.2 Cause of Subgaleal Haematoma Traumatic Separation of the Galea from the Periosteum Migration of Intracranial Blood and/or Liquor to the Subgaleal Space 5.2.3.3 Manner of Subgaleal Haematoma Intrauterine Trauma Trauma During Birth Trauma After Birth: Accidental or Non-accidental Accidental Traction Accidental Impact Trauma/Blunt Force Trauma Non-accidental Traction Non-accidental Impact Trauma/Blunt Force Trauma 5.2.3.4 Differential Diagnosis of Subgaleal Haematoma Other Scalp Haematomas Coagulation Disorders Other Disorders The Use of Anticoagulants 5.2.3.5 Dating Subgaleal Haematomas 5.2.4 Cephalhaematoma 5.2.4.1 Introduction 5.2.4.2 Cause and Manner of Cephalhaematoma 5.3 Calvarium Fractures 5.3.1 Introduction 5.3.2 Cause of Calvarium Fractures 5.3.2.1 Static Loading Defining Static Loading Injuries to the Head in Static Loading 5.3.2.2 Dynamic Impact Loading Defining Dynamic Impact Loading Injuries to the Head in Dynamic Impact Loading Child’s Versus Adult’s Calvarium in Dynamic Impact Loading Deformation in Dynamic Impact Loading: Trauma-Related and Anatomy-Related Factors Trauma-Related Factors: Location of the Impact Trauma-Related Factors: Amount of Energy Transferred At the Impact Anatomy-Related Factors: The Scalp Anatomy-Related Factors: The Age of the Child Anatomy-Related Factors: Shape, Build, and Thickness of the Skull 5.3.3 Manner of Calvarium Fractures 5.3.3.1 Trauma Before Birth Trauma Before Birth Due to Static Loading Trauma Before Birth Due to Dynamic Impact Loading Trauma Before Birth Due to Dynamic Impact Loading: Accidental Circumstances Trauma Before Birth Due to Dynamic Impact Loading: Non-accidental Circumstances Disease-Related Intrauterine Calvarium Fractures 5.3.3.2 Trauma During Birth Trauma During Birth Due to Static Loading Disease-Related Calvarium Fractures Due to Trauma During Birth 5.3.3.3 Trauma After Birth: Static Loading Accidental Circumstances Non-accidental Circumstances 5.3.3.4 Trauma After Birth: Dynamic Impact Loading—Accidental Circumstances Accidents: Falls Accidental Short-Distance Falls Uncomplicated Short-Distance Falls in Living Children Experimental Uncomplicated Short-Distance Falls in Deceased Children Complicated Short-Distance Falls Falls from the Arms of Parent or Caregiver Falls on Objects Accidental Short- and Intermediate-Distance Falls Falls from Furniture Falls From or with Stroller Falls from Baby Carriers, Bouncy Chairs, Baby Bouncers, and Car Seats Falls from High Chairs Falls from Shopping Carts Falls from Bunk Beds Falls During Playing and Sporting Activities Accidental Long-Distance Falls Long-Distance Free Falls and Falls From Windows, Balconies, and Rooftops Long-Distance Falls from Playing Equipment Long-Distance Falls from Stairs Falls with Baby Walkers, Including Walker Falls from Stairs Accidents: Toppling Televisions and Other Falling Heavy Objects Accidental Circumstances: Traffic Accidents Accidental Circumstances: Daily Activities 5.3.3.5 Trauma After Birth: Non-accidental Circumstances Epidemiology Differential Diagnosis, Based on Type of Calvarium Fractures 5.3.3.6 Medical Differential Diagnosis of Calvarium Fractures Due to Trauma After Birth 5.3.4 Types of Calvarium Fractures 5.3.4.1 Introduction 5.3.4.2 Simple (Single Line)/Linear or Curvilinear Calvarium Fractures 5.3.4.3 Symmetrical or Bilateral Linear Calvarium Fractures 5.3.4.4 Complex and Comminuted Calvarium Fractures 5.3.4.5 Complete and Incomplete Depressed Calvarium Fractures 5.3.4.6 Growing Fractures of the Calvarium Introduction Cause of Growing Fractures Manner of Growing Fractures Trauma Before Birth Trauma During Birth Trauma After Birth 5.3.4.7 Normal Variants Simulating Fractures Sutures Accessory Sutures The Occipital Bone The Parietal Bone Fractures Versus Accessory Sutures 5.3.5 Calvarium Fractures and Intracranial Injuries 5.3.6 Dating of Calvarium Fractures 5.3.6.1 Soft Tissue Swelling 5.3.6.2 Radiological Characteristics 5.4 Basilar Fractures 5.4.1 Introduction 5.4.2 Cause and Manner of Basilar Fractures 5.4.3 Differential Diagnosis of Basilar Fractures 5.5 Orofacial Bone Fractures and Dental Trauma 5.5.1 Introduction 5.5.2 Cause of Orofacial Bone Fractures 5.5.3 Manner of Orofacial Bone Fractures 5.5.3.1 Accidental and Non-accidental Circumstances 5.5.3.2 Manner, Fracture Location, Gender, and Age of Sustaining 5.5.3.3 Manner and the Occurrence of Associated Injuries 5.5.4 Mandibular Fractures 5.5.4.1 Mandibular Fractures in Children Under the Age of 2 Years Mandibular Fractures in the Neonatal Period Mandibular Fractures Between 1 Month and 2 Years of Age 5.5.4.2 Mandibular Fractures in Children Above the Age of 2 Years Mandibular Fractures in Children Between 2 and 12 Years of Age Mandibular Fractures in Children Older than 12 Years of Age 5.5.5 Midfacial (Maxillary and Zygomatic Arch) Fractures 5.5.6 Orbital Fractures 5.5.6.1 General Aspects of Orbital Fractures 5.5.6.2 Orbital Rim Fractures 5.5.6.3 Orbital Floor Fractures Direct Orbital Floor Fractures Indirect Orbital Floor Fractures 5.5.6.4 Orbital Roof Fracture 5.5.6.5 Orbital Fractures Due to Trauma During Birth 5.5.6.6 Orbital Fractures Due to Trauma After Birth General Aspects of Orbital Fractures Due to Trauma After Birth Gender and Orbital Fractures Due to Trauma After Birth Location of the Orbital Fractures and Age of Sustaining 5.5.7 Nasal Bone and Nasal Septum Fractures 5.5.8 Frontal Bone Fractures 5.5.9 Dental Trauma, Dental Neglect, and Gingival Injuries 5.5.9.1 Dental Trauma Introduction Cause and Manner of Dental Trauma 5.5.9.2 Dental Neglect 5.5.9.3 Gingival Injuries 5.6 Intracranial Injuries 5.6.1 Introduction 5.6.2 Trauma-Related Intracranial Findings 5.6.3 Cause of Trauma-Related Intracranial Findings 5.6.4 Manner of Trauma-Related Intracranial Injuries 5.6.4.1 Trauma-Related Intracranial Injuries Sustained During Birth Subdural Haematoma Retinal Haemorrhages 5.6.4.2 Trauma-Related Intracranial Injuries Sustained After Birth 5.6.4.3 Medical Conditions in the Differential Diagnosis of Physical Findings in Inflicted Head Trauma 5.6.5 Intracranial Injuries and Skull Fractures 5.6.5.1 General Aspects of Intracranial Injuries in Children with Skull Fractures 5.6.5.2 Intracranial Injuries in Children with Linear Skull Fractures 5.6.5.3 Intracranial Injuries in Children with Depressed Skull Fractures References 6: Spine 6.1 General Aspects of Spinal Fractures 6.1.1 Clinical Presentation 6.1.2 Epidemiology 6.1.2.1 Age-Related Incidence and Male-to-Female Ratio 6.1.2.2 Location and Age-Related Level of Fractures 6.1.2.3 Cord Lesions and SCIWORA 6.1.2.4 Associated Injuries and Mortality 6.2 Cause of Spinal Fractures 6.3 Manner of Spinal Injuries 6.3.1 Trauma After Birth: Accidental Trauma 6.3.2 Trauma After Birth: Non-accidental Trauma 6.3.2.1 Clinical Aspects and Epidemiology 6.3.2.2 Non-accidental Spinal Injuries and Associated Injuries 6.3.2.3 Spinal Injuries in Fatally Abused Children 6.4 Cervical Spine Injuries 6.4.1 Specific Aspects of Cervical Spine Injuries 6.4.2 Manner of Cervical Spine Injuries 6.4.2.1 Trauma Before Birth 6.4.2.2 Trauma During Birth 6.4.2.3 Trauma After Birth: Accidental Circumstances 6.4.2.4 Trauma After Birth: Non-accidental Circumstances Clinical Aspects and Epidemiology Non-accidental Cervical Spine Injuries and Associated Injuries 6.5 Thoracolumbar Spine Injuries 6.5.1 Specific Aspects of Thoracolumbar Spine Injuries 6.5.2 Manner of Thoracolumbar Spine Injuries 6.5.2.1 Trauma Before Birth 6.5.2.2 Trauma During Birth 6.5.2.3 Trauma After Birth: Accidental Circumstances 6.5.2.4 Trauma After Birth: Non-accidental Circumstances Fractures and Fracture Dislocations Spinal Subdural and Epidural Haemorrhage 6.6 Injuries to the Sacrum and Coccyx 6.6.1 Specific Aspects of Injuries of the Sacrum and Coccyx 6.6.2 Manner of Injuries of the Sacrum and Coccyx 6.6.2.1 Trauma Before and During Birth 6.6.2.2 Trauma After Birth: Accidental Circumstances 6.6.2.3 Trauma After Birth: Non-accidental Circumstances 6.7 Differential Diagnosis References 7: Ribs 7.1 General Aspects of Rib Fractures 7.2 Cause of Rib Fractures 7.2.1 Static Loading: Compression 7.2.2 Dynamic Impact Loading 7.3 Manner of Rib Fractures 7.3.1 Trauma Before Birth 7.3.2 Trauma During Birth 7.3.3 Trauma After Birth: Accidental and Non-accidental Circumstances 7.3.3.1 Epidemiology of Rib Fractures, Due to Trauma After Birth 7.3.3.2 Morbidity and Mortality Associated with Rib Fractures 7.3.3.3 Accidental Versus Non-accidental Rib Fractures 7.3.3.4 Non-accidental Rib Fractures General Aspects of Non-accidental Rib Fractures Posterior Rib Fractures Fractures of the First Rib Injuries to the Costochondral Junction Rib Fractures as Indication for Respiratory Obstruction by Chest Compression 7.3.4 Trauma After Birth: Medical Procedures 7.3.4.1 Resuscitation and Rib Fractures General Aspects of Resuscitation Two-Finger Cardiopulmonary Resuscitation and Two-Thumb-Encircling Hands Chest Compression Rib Fractures, Due to Resuscitation: Epidemiological Data Rib Fractures, Due to Resuscitation: Concluding Remarks Other Injuries, Due to Resuscitation 7.3.4.2 Physiotherapy, Chiropractic Care, and Rib Fractures 7.3.4.3 Surgical Interventions and Rib Fractures 7.3.5 Trauma after Birth: Medical Conditions 7.3.5.1 Rib Fractures in Preterm Children 7.3.5.2 Rib Fractures in Children with Bone Disease Osteogenesis Imperfecta and Rib Fractures Rickets and Rib Fractures Menkes Disease and Rib Fractures Metabolic Disturbances and Rib Fractures Osteopetrosis and Rib Fractures 7.3.5.3 Rib Fractures in Serious Coughing Fits 7.3.5.4 Bone Disease: Concluding Remarks 7.4 Penetrating Chest Trauma 7.4.1 General Aspects of Penetrating Chest Trauma 7.4.2 Penetrating Chest Trauma: Accidental Circumstances 7.4.3 Penetrating Chest Trauma: Non-accidental Circumstances 7.4.3.1 Non-accidental Trauma at Home 7.4.3.2 Non-accidental Trauma outside the Home 7.4.3.3 Non-accidental Trauma in Conflicts and Wartime 7.5 Differential Diagnosis References 8: Clavicle 8.1 General Aspects of Clavicle Fractures 8.2 Cause of Clavicle Fractures 8.2.1 Direct Trauma with High Energy Transfer 8.2.2 Indirect Trauma 8.3 Manner of Clavicle Fractures 8.3.1 Trauma Before Birth 8.3.2 Trauma During Birth 8.3.3 Trauma After Birth: Accidental Circumstances 8.3.4 Trauma After Birth: Iatrogenic 8.3.5 Trauma After Birth: Non-accidental Circumstances 8.4 Differential Diagnosis of Clavicle Fractures References 9: Sternum 9.1 General Aspects of Sternum Fractures 9.2 Cause of Sternum Fractures 9.2.1 Direct Trauma 9.2.2 Indirect Trauma 9.2.2.1 Distortion 9.2.2.2 Fatigue Fractures in Normal Bone: Stress Fractures 9.2.2.3 Fatigue Fractures in Weakened Bone: Insufficiency Fractures 9.3 Manner of Sternum Fractures 9.3.1 Trauma After Birth: Accidental Circumstances 9.3.2 Trauma After Birth: Medical and Paramedical Procedures 9.3.3 Trauma After Birth: Non-accidental Circumstances 9.4 Differential Diagnosis of Sternum Fractures 9.4.1 Sternal Segment Dislocations 9.4.2 Self-limiting Sternal Tumour of Childhood References 10: Scapula 10.1 General Aspects of Scapula Fractures 10.2 Cause of Scapula Fractures 10.2.1 Direct Trauma with High-energy Transfer 10.2.2 Indirect Trauma 10.2.3 Traction Trauma 10.2.4 Cause of Scapula Fractures on Specific Locations 10.3 Manner of Scapula Fractures 10.3.1 Trauma After Birth: Accidental Circumstances 10.3.2 Trauma After Birth: Medical and Paramedical Procedures 10.3.3 Trauma After Birth: Non-accidental Circumstances 10.4 Differential Diagnosis of Scapula Fractures References 11: Pelvis 11.1 General Aspects of Pelvic Fractures 11.2 Cause of Pelvic Fractures 11.2.1 Direct Trauma with High-Energy Transfer 11.2.2 Indirect Trauma with Low(er) Energy Transfer: Overuse Fractures 11.2.2.1 Apophyseal Avulsion Fractures 11.2.2.2 Fatigue Fractures in Normal Bone: Stress Fractures 11.2.2.3 Fatigue Fractures in Weakened Bone: Insufficiency Fractures 11.3 Manner of Pelvic Fractures 11.3.1 Trauma After Birth: Accidental Circumstances 11.3.2 Trauma After Birth: Sporting Activities 11.3.2.1 Apophyseal Avulsion Fractures 11.3.2.2 Fatigue Fractures in Normal Bone: Stress Fractures 11.3.2.3 Trauma After Birth: Non-accidental Circumstances 11.4 Paediatric Versus Adult Pelvic Fractures 11.4.1 High-energy Trauma: Pelvis Ring Fractures 11.4.2 High-energy Trauma: Acetabulum Fractures 11.4.3 Lower Energy Trauma: Apophyseal Avulsion Fractures 11.5 Differential Diagnosis of Pelvic Fractures References 12: Extremities 12.1 General Aspects of Fractures of the Extremities 12.2 Fractures of the Diaphysis 12.2.1 Cause of Fractures of the Diaphysis 12.2.2 Manner of Fractures of the Diaphysis 12.3 Fractures of the Metaphysis and Epiphysis 12.3.1 Introduction 12.3.2 Metaphyseal Corner Fracture 12.3.2.1 Introduction 12.3.2.2 Cause of Metaphyseal Corner Fractures 12.3.2.3 Manner of Metaphyseal Corner Fractures 12.3.2.4 Differential Diagnosis 12.3.3 Salter–Harris Fractures 12.3.3.1 Introduction 12.3.3.2 Cause of Salter–Harris Fractures 12.3.3.3 Manner of Salter–Harris Fractures 12.3.4 Epiphyseal Transitional Fractures 12.4 Humerus 12.4.1 General Aspects of Humerus Fractures 12.4.2 Fractures of the Proximal Humerus 12.4.2.1 General Aspects of Fractures of the Proximal Humerus 12.4.2.2 Cause and Manner of Fractures of the Proximal Humerus During Birth After Birth: Accidental and Non-accidental Circumstances 12.4.3 Fractures of the Humerus Shaft 12.4.3.1 General Aspects of Humeral Shaft Fractures 12.4.3.2 Cause and Manner of Humeral Shaft Fractures Before Birth During Birth After Birth: Accidental or Non-accidental Circumstances After Birth: The ‘Hymel manoeuvre’ After Birth: Underlying Medical Conditions 12.4.4 Fractures of the Distal Humerus 12.4.4.1 General Aspects of Fractures of the Distal Humerus 12.4.4.2 Supracondylar Fractures: Epidemiology, Cause, and Manner 12.4.4.3 Fractures of the Lateral Condyle: Epidemiology, Cause, and Manner 12.4.4.4 Fractures of the Medial Condyle: Epidemiology, Cause, and Manner 12.4.4.5 Fractures of the Medial Epicondyle: Epidemiology, Cause, and Manner 12.4.4.6 Transphyseal Fractures: Epidemiology, Cause, and Manner 12.4.4.7 Capitellum Fracture: Epidemiology, Cause, and Manner 12.5 Radius and Ulna 12.5.1 General Aspects of Fractures of the Radius and Ulna 12.5.2 Cause of Fractures of the Radius and Ulna 12.5.3 Manner of Fractures of the Radius and Ulna 12.5.3.1 Before Birth 12.5.3.2 During Birth 12.5.3.3 After Birth: Accidental Circumstances 12.5.3.4 After Birth: Non-accidental Circumstances 12.5.4 ‘Nursemaid’s Elbow’ 12.5.4.1 General Aspects of the ‘Nursemaid’s elbow’ 12.5.4.2 Cause and Manner of the ‘Nursemaid’s elbow’ 12.6 Fractures of the Hand 12.6.1 General Aspects of Fractures of the Hand 12.6.2 Cause and Manner of Fractures of the Hand 12.7 Femur 12.7.1 General Aspects of Femur Fractures 12.7.2 Fractures of the Proximal Femur 12.7.2.1 General Aspects of Fractures of the Proximal Femur 12.7.2.2 Cause of Fractures of the Proximal Femur in Normal Bone 12.7.2.3 Manner of Fractures of the Proximal Femur Before Birth During Birth After Birth: Accidental or Non-accidental Trauma After Birth: Diseases with an Increased Risk of Fractures of the Proximal Femur 12.7.3 Fractures of the Femoral Shaft 12.7.3.1 General Aspects of Fractures of the Femoral Shaft 12.7.3.2 Cause of Fractures of the Femoral Shaft 12.7.3.3 Manner of Fractures of the Femoral Shaft Before Birth During Birth After Birth: Accidental and Non-accidental Circumstances After Birth: Differentiating Accidental from Non-accidental Circumstances After Birth: Traditional Massage, Physiotherapy, and Medical Procedures After Birth: Diseases with an Increased Risk of Femoral Shaft Fractures 12.7.4 Fractures of the Distal Femur 12.7.4.1 General Aspects of Fractures of the Distal Femur 12.7.4.2 Cause of Fractures of the Distal Femur 12.7.4.3 Manner of Fractures of the Distal Femur Before Birth During Birth After Birth: Accidental or Non-accidental Trauma After Birth: Diseases with an Increased Risk of Fractures of the Distal Femur 12.8 Tibia and Fibula 12.8.1 General Aspects of Fractures of the Tibia and Fibula 12.8.2 Cause of Fractures of the Tibia and Fibula 12.8.3 Manner of Fractures of the Tibia and Fibula 12.8.3.1 Before Birth 12.8.3.2 During Birth 12.8.3.3 After Birth: Accidental Circumstances 12.8.3.4 After Birth: Non-accidental Circumstances 12.9 Fractures of the Foot 12.9.1 General Aspects of Fractures of the Foot 12.9.2 Cause and Manner of Fractures of the Foot 12.10 Subperiosteal Haemorrhage and Periosteal Reaction 12.10.1 Traumatic Sub-periosteal Haemorrhage 12.10.2 Periosteum, Periosteal Reaction, and the Healing of Fractures 12.11 Growth Arrest Lines 12.11.1 General Aspects of Growth Arrest Lines 12.11.2 Growth Arrest Lines Due to Childhood Medical Conditions 12.11.3 Growth Arrest Lines Due to Non-organic Failure to Thrive References 13: Accidental Trauma 13.1 Introduction 13.2 Birth Trauma 13.2.1 Introduction 13.2.2 Incidence and Prevalence of Fractures Resulting from Birth 13.2.3 Conclusion 13.3 Accidental Fractures 13.3.1 General Considerations 13.3.2 Short-Distance Fall, Serious Injuries, Hospital Admissions, and Death 13.3.2.1 Introduction 13.3.2.2 Data from Literature 13.3.2.3 Conclusions 13.3.3 Fall from a Considerable Height 13.3.3.1 Introduction 13.3.3.2 Data from Literature 13.3.3.3 Conclusions 13.3.4 Fall with Caretaker 13.3.4.1 Introduction 13.3.4.2 Conclusion 13.3.5 Falls Involving Objects 13.3.5.1 Bed or Couch Introduction Data from Literature Conclusions 13.3.5.2 Bunk Bed Introduction Data from Literature Conclusions 13.3.5.3 Pram Introduction Data from Literature Conclusions 13.3.5.4 Infant Seating Device Introduction Bounce Chair Data from Literature Car Seat Data from Literature Conclusions 13.3.5.5 High Chair Introduction Data from the Literature Conclusions 13.3.5.6 Baby Jumpers Introduction Data from Literature Conclusions 13.3.5.7 Exersaucer Introduction Data from Literature Conclusions 13.3.5.8 Baby Walker Introduction Data from Literature Conclusions 13.3.5.9 Stair Introduction Data from Literature Conclusions 13.3.5.10 Shopping Cart Introduction Data from Literature Conclusions 13.3.5.11 Trampoline Introduction Data from Literature Conclusions 13.4 Medical Procedures 13.4.1 Introduction 13.4.2 Medical Procedures 13.4.2.1 Physical Examination 13.4.2.2 Lines and Punctures 13.4.2.3 Orthopaedic Surgery in Clubfeet 13.4.2.4 Physiotherapy 13.5 Sports 13.5.1 Introduction 13.5.2 Data from Literature 13.5.2.1 Acute Fractures 13.5.2.2 Chronic Osseous Injuries (Stress Injuries) References 14: Normal Variants, Congenital, and Acquired Disorders 14.1 Introduction 14.2 Normal Variants 14.2.1 Subperiosteal New-Bone Formation 14.2.2 Metaphyseal Variants 14.2.3 Variants of the Cortex 14.2.4 Accessory Growth Centres and Sutures 14.3 Osteogenesis Imperfecta 14.3.1 Introduction 14.3.2 Clinical Presentation 14.3.3 Additional Examinations 14.3.4 Osteogenesis Imperfecta and Non-accidental Trauma 14.4 Rickets 14.4.1 Introduction 14.4.2 Clinical History—Clinical Manifestations 14.4.3 Physical Examination 14.4.4 Biochemical Testing 14.4.5 Radiological Examination 14.4.6 Rickets and Non-accidental Trauma 14.5 Syndromes and Congenital Disorders 14.5.1 Introduction 14.5.2 Sickle Cell Anaemia 14.5.3 Alagille Syndrome 14.5.4 Duchenne Muscular Dystrophy 14.5.5 Congenital Pseudarthrosis 14.5.6 Caffey’s Disease 14.5.7 Menkes Disease 14.5.8 Pain Insensitivity in Spina Bifida 14.5.9 Congenital Pain Insensitivity 14.6 Skeletal Dysplasias 14.6.1 Introduction 14.6.2 Metaphyseal Chondroplasia Type Schmid 14.6.3 Spondylometaphyseal Dysplasia ‘Corner Fracture Type’ 14.6.4 X-Linked Hypophosphatemia 14.7 Metabolic Disorders 14.7.1 Introduction 14.7.2 Osteopetrosis 14.7.3 Osteoporosis 14.7.4 Dysostosis Multiplex Congenita 14.7.5 Hypophosphatasia 14.8 Infectious Diseases 14.8.1 Introduction 14.8.2 Osteomyelitis 14.8.3 Chronic Relapsing Multifocal Osteomyelitis 14.8.4 Congenital Syphilis 14.9 Oncological Diseases 14.9.1 Introduction 14.9.2 Malignancies 14.9.2.1 Leukaemia 14.9.2.2 Ewing Sarcoma 14.9.3 Benign Diseases 14.9.3.1 Osteoid Osteoma 14.9.3.2 Bone Cysts 14.10 Medication-Related Abnormalities 14.10.1 Introduction 14.10.2 Corticosteroids 14.10.3 Methotrexate 14.10.4 Hypervitaminosis A 14.10.5 Prostaglandins 14.10.6 Bisphosphonates 14.11 Other Disorders 14.11.1 Blount’s Disease 14.11.2 Epilepsy 14.11.3 Vitamin C Deficiency 14.11.3.1 Vitamin C Deficiency and Suspected Non-accidental Trauma 14.11.4 Copper Deficiency References 15: The Role of the Expert Witness and the Abuse of Differential Diagnoses in Court 15.1 Introduction 15.2 Expert Witness 15.2.1 Duties and Responsibilities of the Expert Witness 15.2.2 The Radiology Report in Court 15.2.3 Guidelines 15.2.4 The Expert Witness in Court: The Differential Diagnosis 15.3 Abuse of Existing Diseases in the Differential Diagnosis 15.3.1 Fractures, Bruises, and Non-Accidental Trauma 15.3.2 Vitamin D Deficiency: Rickets 15.3.2.1 Vitamin D Levels 15.3.2.2 The Keller and Barnes Commentary on Rickets Versus Child Abuse 15.3.2.3 Other Publications Concerning Rickets Versus Child Abuse Court Case 1 Court Case 2 15.3.2.4 The Scientific Evidence Concerning Rickets Versus Child Abuse 15.3.3 Vitamin C Deficiency, Vaccinations, and Fractures 15.3.4 Ehlers–Danlos Syndrome 15.3.4.1 Ehlers–Danlos Syndrome and Suspected Non-Accidental Trauma 15.3.5 Copper Deficiency 15.4 Non-Existing Disease in the Differential Diagnosis 15.4.1 Temporary Brittle Bone Disease References 16: The Use and Misuse of the Medical Literature 16.1 Introduction 16.2 Evidence-Based Medicine 16.3 Journals 16.3.1 Introduction 16.3.2 Editorial Boards and Editors 16.3.3 Journal Quality 16.4 Peer Review 16.5 Literature Appraisal 16.5.1 Materials and Methods 16.5.1.1 Study Designs 16.5.1.2 Methodological Pitfalls 16.5.2 References 16.6 Rhetorical Pitfalls 16.6.1 Association Is Not Causation 16.6.2 Hasty Generalizations 16.6.3 Argument from Ignorance (Argumentum Ad Ignorantiam) 16.7 Examples of Misuse of the Medical Literature 16.7.1 Hypoxia as a Cause for the Findings in AHT 16.7.2 The Absence of Any Published Support for AHT 16.8 Summary References 17: Bayesian Interpretation of Paediatric Fractures 17.1 Introduction 17.2 Bayesian Statistics 17.2.1 Prior Probability of Abuse 17.2.2 Diagnostic Value 17.2.3 Posterior Probability of Abuse 17.3 Diagnostic Value 17.4 Conclusion References