Fatal non-accidental injury in South Africa: A Gauteng hospital’s perspective on the incidence and fracture types in post-mortem skeletal surveys

SA Journal of Radiology

Field Value
Title Fatal non-accidental injury in South Africa: A Gauteng hospital’s perspective on the incidence and fracture types in post-mortem skeletal surveys
Creator Wessels, Robyn M. Moodley, Halvani
Subject Forensic imaging;Fatal non-accidental injury;Paediatrics fatal non-accidental injury; post-mortem skeletal surveys; PMSS; NAI; live skeletal surveys; LSS
Description Background: In its severest form, non-accidental injury (NAI) in children is fatal. South Africa has been reported to have double the global average of child homicides. Autopsy is the main investigation in fatal NAI with post-mortem skeletal surveys (PMSS) playing an adjunctive role. Whilst fracture patterns associated with NAI in living patients have been established, this has not been investigated in PMSS in South Africa.Objectives: To determine the incidence and characteristics of fractures in suspected fatal NAI cases. To calculate the incidence of fractures according to high-, moderate- and low-specificity fracture locations for NAI.Methods: A retrospective review of all PMSS performed between 01 January 2012 and 03 December 2018 was conducted at the Charlotte Maxeke Johannesburg Academic Hospital.Results: Of the 73 PMSS, 33 (45.2%) demonstrated fractures. No statistical significance in sex was found: 38 (52.1%) were male and 35 (47.9%) were female (p  0.05). The mean age of those who sustained fractures was 28 months (standard deviation [s.d.]: 21 months). A total of 115 fractures were sustained, of that the top five bones fractured were the ribs 37 (32.2%), parietal bone 13 (11.3%), ulna 13 (11.3%), femur 13 (11.3%), and radius 11 (9.6%). High-specificity fracture locations accounted for 40/133 (30.1%).Conclusion: The fracture types in PMSS were similar to those in live skeletal surveys. Our study’s fracture rate was higher in comparison to international studies. The PMSS is a valuable adjunct to autopsy in detecting occult fractures of the limbs. We recommend that PMSS be performed in suspected fatal NAI cases at least in children up to 24 months of age.
Publisher AOSIS
Contributor Medical Research Council assisted with statistical analysis
Date 2022-02-22
Type info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion — Retrospective review
Format text/html application/epub+zip text/xml application/pdf
Identifier 10.4102/sajr.v26i1.2311
Source South African Journal of Radiology; Vol 26, No 1 (2022); 7 pages 2078-6778 1027-202X
Language eng
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https://sajr.org.za/index.php/sajr/article/view/2311/3117 https://sajr.org.za/index.php/sajr/article/view/2311/3118 https://sajr.org.za/index.php/sajr/article/view/2311/3119 https://sajr.org.za/index.php/sajr/article/view/2311/3120
Coverage South Africa;Gauteng 2012-2018 Age;Gender
Rights Copyright (c) 2022 Robyn Meryl Wessels, Halvani Moodley https://creativecommons.org/licenses/by/4.0