Forensic Pathology: 
The Postmortem Examination
Autopsy as excavation of the body
Data Collection at the Postmortem Examination
Collect Contextual Information
•	Clothing: Condition and position
•	Differential Decomposition Patterns
•	External Evidence of Trauma
•	Entomological Specimen Collection
•	Radiographic Examination

Recognition of Child Abuse
►	Child Abuse (physical abuse): 
•	“when an infant or child suffers repetitive physical injuries by a parent or guardian, in circumstances that exclude accident” (Knight 1991:422)
►	Evidenced By:
•	Specific and Definitive Trauma Patterns
•	Evidence of Multiple or Repetitive Traumatic Episodes that are Temporally Distinct

Skeletal Trauma in Child Abuse
►	Cranial Trauma
•	Visible grossly and radiographically
•	Associated with behavioral/physical responses
•	Associated with intracranial hemorrhaging
►	Appendicular Skeleton
•	Fractures/evulsions at metaphyseal/ epiphyseal junctions (“bucket handle” or “corner” fractures)
•	Spiral Fractures

Skeletal Trauma in Child Abuse
►	Thoracic Region
•	Most commonly described near rib angles and attributed to anteroposterior compression
•	Rib fractures found on other regions of the ribs = direct blow
•	New fractures often “hidden” due to soft tissue obstruction and difficulty of radiographic detection

Kleinman’s (1996) Radiographic Protocols in Suspected Child Abuse Cases
►	All infants with suspected abuse should undergo a radiologic skeletal survey
•	Skeletal scintigraphy can be used (with caution) as a primary screening tool
►	Survey must be performed with high detail systems and meticulous attention to technique
•	E.g., single-emulsion film, single rare-earth screen and carbon-fiber cassette (resulting in maximal spatial and contrast resolution)
►	Repeat skeletal imaging in 7-10 days

Comprehensive Osteological Analysis
►	Documentation of Trauma: Specific location, morphology, severity, degree of healing, and biomechanical reconstructions
►	In all cases of suspected child abuse … protocol should include comprehensive forensic osteological analysis

Trauma to thoracic structures due to:
►	Anteroposterior Compression
►	Shaking Syndrome
•	Trauma to cervicocranial region
•	Trauma to appendicular skeleton
►	Cardiopulmonary Resuscitation Effects
•	Trauma to thorax rare
•	Typically effects sternochondral junction only
Effects of Compression Forces on the Infant Thorax
Problems with Identification of Anteroposterior Compression Trauma (without Osteological Analysis)
►	Standard Radiographic protocols
•	Insufficient Detail or improper orientation
►	Analysis at the postmortem examination
•	Underestimate trauma (obstruction by soft tissue)
•	Focus of rib angles
Conclusions
►	Multidisciplinary approach to identifying child abuse evidence in the thoracic region essential
►	Forensic osteological analysis of retained bones has proven extremely beneficial:
•	Healing evidence clarified
•	Biomechanical interpretation of bending forces vs. direct blow
•	Identification of bending deformation that does not result in fracture (radiologically invisible)