Skull fractures in abusive head trauma: a single centre experience and review of the literature

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.

Automated summary

This study provides a comprehensive framework for approaching paediatric calvarial injuries suspected to be a result of abusive head trauma (AHT), highlighting the unique morphology of infant skulls and potential diagnostic pitfalls. A retrospective analysis of sixty-three patients revealed various types of skull fractures, with most being simple linear fractures of the parietal bones. The study identifies fracture mimics and adds to the existing literature on the subject, offering insights into the spectrum of calvarial damage caused by AHT and its diagnostic challenges.