Anat Biol Anthropol.  2024 Sep;37(3):173-180. 10.11637/aba.2024.37.3.173.

Forensic Anthropological Implication of Undetected Rib Fractures in Child Abuse Case

• Lee J
• Park DK

• KMID: 2562492
• DOI: http://doi.org/10.11637/aba.2024.37.3.173

Abstract

Forensic anthropologists play a crucial role in estimating the biological profile of skeletonized bones, including identifying fractures and taphonomic changes. It is also important to analyze the fracture patterns that occur in infants or children younger than 5 years because family members can cause the fractures. The aim of this study is to promote meticulous diagnosis and prevent child abuse by raising awareness among medical professionals. This case is for a male neonate who tragically passed away approximately five months after birth. According to the first hospital record, his right humerus was fractured due to his four-year-old sister pulling on his hand while his mother held him and tried to stand up. The diagnosis was made by X-ray images of the right humerus and the normal left humerus. After 17 days, a follow-up examination X-ray confirmed positive progress in treating the fracture. However, the child was later found dead at home, prompting an autopsy. The autopsy revealed not only the humeral fracture but also skull fractures and subdural hemorrhage. These findings led the police to re-examine the child’s previous hospital records. A forensic anthropologist identified possible fracture sites and calluses. Interestingly, the X-ray image of the right humeral fracture accidentally captured fractures in the 3rd to 8th left ribs, which were not visibly damaged. The follow-up X-ray, taken 17 days after the initial fracture, also revealed calluses in the same rib region. These observations were diagnosed by a professor of diagnostic radiology. Long bone fractures and rib fractures in infants or young children are frequently associated with “shaken baby syndrome” and “abusive head trauma.” Had the rib fractures been identified during the initial diagnosis of the right humeral fracture and reported as suspected child abuse, the child’s life might have been spared. However, if the radiologist focuses only on major fracture sites, it is possible that they may overlook the possibility of fractures in other parts of the body. It tends to underscores the importance of considering fractures in various body parts beyond major sites. In diagnosis of limb fractures in infants or young children, forensic discipline such as forensic anthropologists and forensic nursing might be helpful to identify overlooked other body part fractures and to exclude child abuse.

Keyword

Bone trauma analysis; Forensic anthropology; Child abuse; Fracture; Diagnosis