Skull fractures in abusive head trauma: a single centre experience and review of the literature
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ORIGINAL ARTICLE
Skull fractures in abusive head trauma: a single centre experience and review of the literature Jai Sidpra 1 & Noor ul Owase Jeelani 2 & Juling Ong 3 & Wendy Birch 4 & Kshitij Mankad 5 Received: 6 March 2020 / Accepted: 21 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose The authors provide a comprehensive framework with which to approach paediatric calvarial injury sustained as a result of suspected abusive head trauma (AHT). This is achieved through the presentation of a case series set in the context of the unique morphology of the infant skull and the possible diagnostic pitfalls which may arise due to the presence of variant anatomy or other mimicking conditions. Methods A retrospective analysis of sixty-three patients referred to our institution with suspected AHT was carried out. Seventeen patients with skull fractures were identified and their fractures were described in terms of anatomical location, type and course. Our data was then interpreted in the light of known anatomical fracture mimics and the available literature on the subject. Results Forty-two skull fractures were identified and described in our cohort, most of which were simple linear fractures of the parietal bones (33%). There were also a substantial number of complex stellate fractures, namely of the parietal (29%) and occipital (10%) bones. Eleven fracture mimics including accessory sutures and wormian bones were also identified in this cohort. Conclusions Our study supports and builds on the existing literature, thereby offering a more complete view of the spectrum of calvarial damage sustained as a result of AHT in the context of its diagnostic pitfalls. Keywords Non-accidental injury . Shaken baby syndrome . Fracture mimics . Traumatic brain injury
Introduction Childhood head injury is a common phenomenon which has the potential to result in significant acute injury and longstanding neurological deficit. Abusive head trauma (AHT) has been shown to account for the majority of morbidity and mortality associated with such injuries in children under the age of 2 years [1, 2]. AHT has also been described in the literature as non-accidental head injury (NAHI) and * Kshitij Mankad [email protected]
shaken baby syndrome (SBS). The diagnosis of AHT is complex and patients may present with non-specific symptoms. Further challenges often arise as a result of the social and medicolegal implications of the diagnosis itself [3–5]. Skull fractures may occur due to either an impaction force, a fall from height, or a shaking and throwing injury [6]. The diagnosis of skull fractures in AHT is complicated by the presence of both anatomical and pathological mimics, for which the radiologist must remain vigilant [7, 8]. This study describes and examines a tertiary paediatric centre’s experience with skull fractures in AHT in the light of this diagnostic and medicolegal complexity.
1
University College London Medical School, London, UK
2
Department of Neurosurgery, Great Ormond Street
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