Undetected traumatic diastasis of cranial sutures: a case of child abuse. (May 2019)

• Record Type: Journal Article
• Authors: Campobasso, Carlo Pietro; De Micco, Francesco; Bugelli, Valentina; Cavezza, Antonio; Rodriguez, William C.; Della Pietra, Bruno
• Is Part Of: Forensic science international. Volume 298(2019)
• Page Start: 307
• Page End: 311
• Publication Date: 2019-05
• Subjects: Child abuse -- Abusive head trauma -- Cranial sutures diastasis -- Skull fractures -- Post-mortem changes -- Forensic anthropology; Medical jurisprudence -- Periodicals; Chemistry, Forensic -- Periodicals; Forensic Medicine -- Periodicals; Médecine légale -- Périodiques; Chimie légale -- Périodiques; Gerechtelijke geneeskunde; Gerechtelijke chemie; Gerechtelijke psychiatrie; Chemistry, Forensic; Medical jurisprudence; Electronic journals; Periodicals; Electronic journals; 614.1
• DOI: 10.1016/j.forsciint.2019.03.011
• Languages: English
• ISSNs: 0379-0738

Abstract

Highlights: A child abuse dealing with undetected diastasis of cranial sutures is reported. Cranial diastasis may occur without other skull fractures resulting from abusive head trauma. Diastasis of the cranial sutures can be also a post-mortem effect of burning/freezing. Differentiation between AM and PM diastasis of cranial sutures is still a challenge. A multidisciplinary approach is recommended to reduce the risk of misdiagnosis. Abstract: Traumatic diastasis of cranial sutures is a type of bone fracture more common in children than in adults, but little attention has been paid to this skull damage. Differentiation between inflicted and accidental traumatic head injury is still a challenge in forensic pathology, particularly in pediatric population. In fact, diastasis of cranial sutures may occur with or without other skull fractures and may be the only evidence of an abusive head trauma (AHT). This is a case study dealing with undetected traumatic diastasis of cranial sutures in child abuse. The skeletonized juvenile remains were found inside a suitcase. A diastasis of the coronal and sagittal sutures was the only finding recorded at the autopsy with no other relevant bone defects. The diastasis was originally attributed by the medical examiner to a physiological unfused stage of the calvarial bones. Therefore, the cause of death was undetermined. Twelve years later an anthropological revision of the cold case showed that diastasis of the coronal and sagittal sutures was assessed as the evidence of an AHT. Analysis of skull fractures in child abuse can be challenging as normal skull suture variants mimicking intentional injury are reported. Diastasis of the cranial sutures can be also a post-mortem effect of burning or freezing. Therefore, a differential diagnosis between natural, accidental or inflicted skull defects is mandatory in death investigation. A multidisciplinary approach in such circumstances is strongly recommended in order to reduce the risk of misdiagnosis.