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Re: Pediatric skull fracture

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  • Re: Pediatric skull fracture

    >I have been attempting to find references dealing with the forces
    >and/or energy necessary to create skull fracture in children
    >(Approximately 18 months). Unfortunately, I have not had much luck.
    >I have information that referenced a "BEVER" out of Germany who did
    >several pediatric skull drops, but there was no citation found in
    >performing a medline search. Medline searches and other attempts for
    >determining these tolerance values have also been fruitless so far.

    Matt-

    The studies you are loooking for were by W. WEBER- Abstracts listed below:

    Z Rechtsmed 1987;98(2):81-93
    [Predilection sites of infantile skull fractures following blunt force]
    [Article in German]
    Weber W.
    Previous investigations on calvarial fractures in infants have
    shown that the flexibility and displacement of the infant calvarial are
    not sufficient to avoid fractures as a result of fall. From a table
    height onto hard ground - and in special cases, fractures cannot be
    avoided even after falls onto softly cushioned ground. The skull
    fractures are located in paper-thin, transparent, single-layer bone
    areas without diploe. The results of previous literature were compared
    with investigations of the skulls of 82 infants (from neonates up to
    infants 14 months of age). Congenital fissures, cranioschisis, locally
    retarded ossification in the cranium and craniotabes are all weak points
    where fracture has a tendency to occur even if the impact is minor.
    These ossification defects are increased in the ossa parietalia, but can
    also be found in the os frontale or in the os occipitale. The location
    is not always the same but can be detected by locating the skull
    transparency using diaphanoscopy.
    ------------------------------------------------------------------------
    Z Rechtsmed 1990;103(4):311-3
    [Pediatric skull fractures and child abuse. A critical comment on the
    contribution "Experimental studies of skull fractures in the infant" by
    W. Weber][Article in German]
    Moller JC
    Z Rechtsmed 1985;94(2):93-101 Related Articles, Books
    --------------------------------------------------------------------------
    [Biomechanical fragility of the infant skull]
    [Article in German]
    Weber W.
    Following previous experiments on postmortem skull fractures of infants,
    falls from 82-cm heights onto stone (A), carpet (B) and foam-backed
    linoleum (C), 35 further falling tests were carried out onto softly
    cushioned ground. In 10 cases a 2-cm thick foam rubber mat (D) was
    chosen and in 25 further cases a double-folded (8-cm-thick) camel hair
    blanket (E). Hence the results of altogether 50 tests could be
    evaluated. In test groups A-C on a relatively hard surface, skull
    fractures of the parietale were observed in every case; in test group D
    this fracture was seen in one case and in test group E in four cases.
    Measurements along the fracture fissures showed bone thickness of
    0.1-0.4 mm. The fracture injuries originated in paper-thin single-layer
    bone areas without diploe, which can also be considered the preferred
    regions for skull fractures of older infants following falls from low
    heights. These results indicate that it is no longer possible to assume
    that the skull of infants is not damaged after falls from table height.
    -----------------------------------------------------------------------
    Z Rechtsmed 1984;92(2):87-94
    [Experimental studies of skull fractures in infants]
    [Article in German]
    Weber W.
    According to pediatric statements, falls from a standing position
    may cause skull fractures in infants without specific symptoms. Nearly
    every infant has at some time fallen from the changing table or the baby
    carriage, etc. From the forensic aspect it is the duty of experts to
    discuss the "battered child syndrome." Evidence given by the defendants
    concerning the height of the fall are unreliable. Experimental test
    series concerned with the stumbling height (82 cm in free fall) and
    three various types of floor-stone, carpet, and foam-backed linoleum
    -were carried out. In each case skull fractures were seen. In three
    cases the fractures crossed the sutures. Conclusions: (1) Each fall of
    an infant from the height of a table may cause a skull fracture, which
    may lead to death; (2) when child mishandling is suspected, all
    circumstances must be taken into consideration.

    Hope this helps.....

    Amy Wicks

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