Abstract

Analysis of the skeletal remains of abused children can prove challenging for forensic pathologists and radiographers who are inexperienced in the direct examination of bones. In such cases, radiographically invisible skeletal lesions that document a history of trauma can often be identified by a physical anthropologist with appropriate osteological experience. This is illustrated by cases in which skeletal remains of four murdered children and a mentally handicapped adult produced evidence of antemortem trauma and perimortem injuries that was critical in developing murder cases against the assailants. In these cases, well-healed areas of subperiosteal new bone formation were identified that were below the threshold of radiographic detection. Such injuries provide strong evidence for a history of physical abuse.

References

1.
Kerley
E R
.
Forensic anthropology and crimes involving children
.
J Forensic Sci
1976
;
21
:
333
-
9
.
2.
Helfer
R E
,
Slovis
T L
,
Black
M
.
Injuries resulting when small children fall out of bed
.
Pediatrics
 0031-4005
1977
;
60
:
533
-
5
.
3.
Root
I
.
Head injuries from short distance falls
.
Am J Forensic Med and Pathol
1992
;
13
(
1
):
85
-
7
.
4.
Haglund
W D
,
Reay
D T
,
Swindler
D R
.
Canid scavenging/disarticulation sequence of human remains in the Pacific Northwest
.
J Forensic Sci
1989
;
34
:
587
-
606
.
5.
Akbarnia
B
,
Torg
J S
,
Kirpatrick
J
,
Sussman
S
.
Manifestations of the battered child syndrome
.
J Bone and Joint Surgery
1974
;
56A
:
1159
-
66
.
6.
Kleinman
P K
,
Marks
S C
,
Adams
V I
,
Blackbourne
B D
.
Factors affecting visualization of posterior rib fractures in abused infants
.
Am J Roentgenol
1988
;
150
(
3
):
635
-
8
.
7.
Fonseca
M A
,
Feigal
R J
,
Bensel
R W
.
Dental aspects of 1248 cases of child maltreatment on file at a major county hospital
.
Pediatric Dent
1992
;
14
(
3
):
152
-
7
.
8.
Park
E A
,
Richter
C P
.
Transverse lines in bone: The mechanisms of their development
.
Bull Johns Hopkins Hosp
1953
;
41
:
364
-
88
.
9.
Park
E A
.
Imprinting of nutritional disturbances on the growing bone
.
Paediatrics
1964
;
33
(Suppl.):
815
-
62
.
10.
Dreizen
S
,
Spirakis
C N
,
Stone
R E
.
The influence of age and nutritional status on “bone scar” formation in the distal end of the growing radius
.
Am J Phys Anthrop
1964
;
22
:
295
-
306
.
11.
Skinner
M
,
Dupras
T
.
Variation in birth timing and location of the neonatal line in human enamel
.
J Forensic Sci
1993
;
38
(
6
):
1383
-
90
.
12.
Maresh
M M
.
Linear growth of long bones of extremities from infancy through adolescence
.
Am J Dis Children
1955
;
89
:
725
-
42
.
13.
Greene
P E
,
Chisick
M C
,
Aaron
G RA
.
Comparison of oral health status and need for dental care between abused neglected children and nonabused nonneglected children
.
Pediatr Dent
1994
;
16
(
1
):
41
-
5
.
14.
Bass
W M
.
Human osteology: A laboratory and field manual of the Human skeleton
. Special Publication,
Missouri Archaeological Society
,
1971
.
15.
Stewart
T D
.
Essentials of forensic anthropology
.
Charles C Thomas
,
Springfield IL
,
1979
.
16.
Krogman
W M
,
Iscan
M Y
.
The human skeleton in forensic medicine
, 2nd edition.
Springfield
,
Charles C Thomas
,
1986
.
17.
White
T D
.
Human Osteology
.
San Diego
,
Academic Press
,
1991
.
18.
Hamill
P V
,
Drizd
T A
,
Johnson
C L
,
Reed
R B
,
Roche
A F
,
NCHS growth curves for children birth-18 years. United States. Vital and health statistics
.
Series 11: Data from the National Health Survey
1977
;
165
:
i–iv
,
1
-
74
.
19.
Walker
P L
,
Perez
A
.
Age height and long bone growth in children
. Unpublished manuscript.
20.
Kleinman
P K
, editor.
Diagnostic imaging of child abuse
.
Williams and Wilkins
,
Baltimore
,
1987
.
21.
Loder
R T
,
Bookout
C
.
Fracture patterns in battered children
.
J Orthop Trauma
1991
;
5
(
4
):
428
-
33
.
22.
Worlock
P
,
Stower
M
,
Barbor
P
.
Patterns of fractures in accidental and nonaccidental injury in children: A comparative study
.
BMJ Clin Res Ed
1986
;
293
(
6539
):
100
-
2
.
23.
Vendugo
M A
,
Bermejo
B G
,
Fuertes
J
.
The maltreatment of intellectually handicapped children and adolescents
.
Child Abuse and Neglect
 0145-2134
1995
;
19
(
2
):
205
-
15
.
24.
Catterall
A
.
Fractures in children
. In:
Watson-Jones
R
,
Wilson
J N
, editors.
Fractures and joint injuries
, 5th edition.
Edinburgh
,
Churchill Livinstone
,
1976
.
25.
Cameron
J N
,
Rae
L J
.
Atlas of the battered child syndrome
.
Edinburgh
,
Churchill Livingstone
,
1975
.
26.
Caffey
J
.
On the theory and practice of shaking infants: Its potential residual effects of permanent brain damage and mental retardation
.
Am J Dis Children
1972
;
124
:
161
-
9
.
27.
Meservy
C J
,
Towbin
R
,
McLaurin
R L
,
Myers
P A
,
Ball
W
.
Radiographic characteristics of skull fractures resulting from child abuse
.
Am J Roentgenol
1987
;
149
(
1
):
173
-
5
.
28.
Gwinn
J L
,
Levin
W
,
Petersen
H G
.
Roentgenographic manifestations of unsuspected trauma in infancy
.
JAMA
1961
;
176
:
926
-
9
.
29.
Hobbs
C J
.
Fractures
.
BMJ
 0959-8138
1989
;
298
:
1015
-
8
.
30.
Kempe
R S
,
Silverman
F N
,
Steele
B F
,
Droegemueller
W
,
Silver
H K
.
The battered child syndrome
.
Am J Med Sci
1962
;
181
(
1
):
17
-
24
.
31.
Kleinman
P K
,
Marks
S C
,
Blackbourne
B
.
The metaphyseal lesion in abused infants: A radiologic histopathologic study
.
Am J Roentgenol
1986
;
146
(
5
):
895
-
905
.
32.
Swischuck
L E
.
Radiology of the skeletal system
. In:
Ellerstein
N S
, editor.
Child abuse and neglect: A medical reference
.
New York
,
John Wiley
,
1981
;
253
-
73
.
33.
Edeiken
J
,
Hodes
P J
,
Caplan
L H
.
New bone production and periosteal reaction
.
Am J Roentgenol, Radium Therapy Nuclear Med
1966
;
97
(
3
):
708
-
18
.
34.
Murphy
S P
,
Sledzik
P S
,
Mann
R W
,
Kelley
M A
.
Macroscopic bone remodeling following trauma: Reconsidering the term perimortem
. Paper presented at the
AAFS meeting
,
Cincinnati (OH)
1990
.
35.
Walker
P L
.
Is the battered-child syndrome a modern phenomenon?
Proceedings of the Xth European Meeting of the Paleopathology Association
(in press).
36.
Heilman
J
,
Neeley
M M
,
Cook
D C
.
Trauma in late woodland crania from Illinois
.
Proceedings of the Indian Acad Sci
1991
;
100
:
1
-
10
.
37.
Shopfner
C E
.
Periosteal bone growth in normal infants. A preliminary report
.
Am J Roentgenol, Radium Therapy, and Nuclear Med
1966
;
97
(
1
):
154
-
63
.
38.
Ditkowsky
S P
,
Goldman
A
,
Barnett
H
,
Baker
M
,
Sammett
J
.
Normal periosteal reactions and associated soft-tissue findings: Relationship to infantile colic and to the Caffey syndrome
.
Clin Pediatr
1970
;
9
(
9
):
515
-
24
.
39.
Rizzolo
P J
,
Coleman
P R
.
Neonatal rib fracture: Birth trauma or child abuse?
J Fam Practice
1989
;
29
(
5
):
561
-
3
.
40.
Paterson
C R
.
Osteogenesis imperfecta and other bone disorders in the differential diagnosis of unexplained fractures
.
J Royal Soc Med
1990
;
83
(
2
):
72
-
4
.
41.
Spencer
J A
,
Grieve
D K
.
Congenital indifference to pain mistaken for nonaccidental injury
.
Brit J Radiol
1990
;
63
(
748
):
308
-
10
.
42.
Duncan
A A
,
Chandy
J
.
Case report: Multiple neonatal fractures dietary or deliberate?
Clin Radiol
1993
;
48
(
2
):
137
-
9
.
43.
Markowitz
R I
,
Hubbard
A M
,
Harty
M P
,
Bellah
R D
,
Kessler
A
,
Meyer
J S
.
Sonography of the knee in normal and abused infants
.
Pediatr Radiol
1993
;
23
(
4
):
264
-
7
.
44.
Karp
R J
,
Scholl
T O
,
Decker
E
,
Ebert
E
.
Growth of abused children. Contrasted with the nonabused in an urban poor community
.
Clin Pediatr
1989
;
28
(
7
):
317
-
20
.
45.
Kempe
R S
,
Goldbloom
R B
.
Malnutrition and growth retardation (“Failure to Thrive”) in the context of child abuse and neglect
. In:
Helfer
R E
,
Kempe
R S
, editors.
The battered child
, 4th ed., revised and expanded,
University of Chicago Press
,
Chicago
,
1987
;
313
-
35
.
46.
Olesen
T
,
Egeblad
M
,
Dige-Petersen
H
,
Ahlgren
P
,
Nielsen
A M
,
Vesterdal
J
.
Somatic manifestations in children suspected of having been maltreated
.
Acta Paediatrica Scand
1988
;
77
(
1
):
154
-
60
.
47.
Taitz
L S
,
King
J M
.
Growth patterns in child abuse
.
Acta Paediatrica Scand
. Supp
1988
;
343
:
62
-
72
.
48.
Wales
J KH
,
Herber
S M
,
Taitz
L S
.
Height and body proportions in child abuse
.
Arch Dis Child
1992
;
67
(
5
):
632
-
5
.
49.
Hobbs
C J
,
Wynne
J M.
Physical signs of child abuse: A color atlas
.
W.B. Saunders
,
London
,
1996
.
50.
Skinner
M
,
Anderson
M PM
.
Individualization and enamel histology: A case report in forensic anthropology
.
J Forensic Sci
1991
;
36
(
3
):
939
-
48
.
51.
Edwards
D K
.
Skeletal growth lines seen on radiographs of newborn infants: Prevalence and possible association with obstetric abnormalities
.
Am J Roentgenol
1993
;
161
(
1
):
141
-
5
.
52.
Campbell
L S
,
Campbell
J D
.
Musculoskeletal trauma in children
.
Critical Care Nursing Clinics North Amer
1991
;
3
(
3
):
445
-
56
.
53.
Yeo
L I
,
Reed
M H
.
Staging of healing of femoral fractures in children
.
Can Assoc Radiol J
1994
;
45
(
1
):
16
-
9
.
54.
Piatier-Piketty
D
,
Zuckman
J
.
The cellular response of the periosteum to trauma: An autoradiographic study of periosteal autografts
.
Israel J Med Sci
1971
;
7
(
3
):
317
-
20
.
55.
Kerley
E R
.
The identification of battered infant skeletons
.
J Forensic Sci
1978
;
23
(
1
):
163
-
8
.
This content is only available via PDF.
You do not currently have access to this content.