Original Research

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

Robyn M. Wessels, Halvani Moodley
South African Journal of Radiology | Vol 26, No 1 | a2311 | DOI: https://doi.org/10.4102/sajr.v26i1.2311 | © 2022 Robyn Meryl Wessels, Halvani Moodley | This work is licensed under CC Attribution 4.0
Submitted: 05 October 2021 | Published: 22 February 2022

About the author(s)

Robyn M. Wessels, Department of Diagnostic Radiology, Faculty of Radiation Sciences, University of the Witwatersrand, Johannesburg, South Africa; and, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
Halvani Moodley, Department of Diagnostic Radiology, Faculty of Radiation Sciences, University of the Witwatersrand, Johannesburg, South Africa; and, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa


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Abstract

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.


Keywords

fatal non-accidental injury; post-mortem skeletal surveys; PMSS; NAI; live skeletal surveys; LSS

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