Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Forensic Medicine-Toxicology

Estimating the timing of skeletal injury appropriately can be of great importance in forensic cases and can have a significant bearing on the judicial process. The aim of this work is to assess dating of long bone fracture healing in paediatrics by radiography (X-Ray) applied for fracture dating which can then be especially important in alleged cases of child abuse. For this study 100 patients of both sex were selected and subdivided into3 main groups.Cases were admitted to Emergency Department of Kasr-Al Ainy hospital during the period from January 2017 to January 2018. Each case had two radiographic spots on the fracture site, from 2 to 4 times during routine management who have long bone fracture and judged to be accidental and of known timing were included in this study.The paediatric radiologist who will be blinded to the identity, age of the child, time and cause of injury assessed each radiograph with irregular time interval. The most commonly affected ages were 21-63 years presenting 68%. Males represented the majority of cases (56%). Most of cases came with fracture radius (55%), the second common site was ulna (14%). Different types of fractures were detected: transverse fracture (37%), green stick (31%), oblique fracture (8%). The illustrated data of each feature form a prototype timetable of fracture healing. These data suggest that fractures with soft-tissue swelling alone are acute fracture (< 1 week old). Fractures with periosteal reaction alone are likely to be recent fracture (between 8 days and 3 weeks old). Once Remodelling, bridging & hard callus fractures detected then old fracture is expected (more than 6 weeks old)

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