In the review by Berthold et al. (1), the authors write that “a linear skull fracture without intracranial injury can even occur after a fall from a low height (the parental bed, for example) onto a hard surface”. This description is undifferentiated and shortened; thus, the statement is false. The evaluation of the question whether or not a history of an accident is credible requires from the evaluating physician extensive own or externally sourced forensic experiences. An example of the uncritical and thus counterproductive dealing with the literature is the way the study by Atkinson et al. (2) is presented. Atkinson et al. classify their “accidents“ according to reports of witnesses of the alleged mechanism of injury without scrutinizing these statements. But exactly this classification of the “accidents” is the responsibility of the attending physician, because in cases of abuse typically a “true” history cannot be obtained. A well-researched overview of falls in children under a wide variety of circumstances by Alexander et al. (3) is not cited at all. This study contradicts the above cited statement of Berthold et al. (1). A good, very useful and differentiated description (also of the biomechanical aspects) is provided by Bilo et al. in their book (4), which is mentioned but unfortunately not discussed in detail.
To be able to offer sound consultation regarding the pathogenesis of childhood fractures, thorough training and extensive experiences are required. In Germany, such specialists are found in forensic medicine (www.dgrm.de) and in the Child Protection Groups in the various Children’s hospitals which are almost always advised in forensic matters. These should be contacted with regard to fractures and not only for a multiprofessional diagnostic evaluation.
Prof. Dr. med. Elisabeth Mützel
Institut für Rechtsmedizin der Medizinischen Fakultät der LMU München, München, Germany
PD Dr. med. Sibylle Banaschak
Institut für Rechtsmedizin der Medizinischen Fakultät der Universität zu Köln, Köln, Germany
Conflict of interest
PD Dr. Banaschak received fees from Springer-Verlag for being an author or co-author of a publication related to this topic.
Prof. Mützel declares no conflict of interest.
|1.||Berthold O, Frericks B, John T, Clemens V, Fegert JM, von Moers A: Abuse as a cause of childhood fractures. Dtsch Arztebl Int 2018; 115: 769–75 VOLLTEXT|
|2.||Atkinson N, van Rijn RR, Starling SP: Childhood falls with occipital impacts. Pediatr Emerg Care 2018; 34: 837–41 CrossRef MEDLINE|
|3.||Alexander RC, Levitt CJ, Smith WL: Abusive head trauma. In: Reece RM, Ludwig S (eds.): Child abuse—medical diagnosis and management. Philadelphia Baltimore New York London: Lippincott Williams and Wilkins 2001; 2nd revised edition, p. 47–80.|
|4.||Bilo RAC, Robben SGF, van Rijin RR: Forensic aspects of pediatric fractures: differentiating accidental trauma from child abuse. Berlin, Heidelberg: Springer 2010 CrossRef|