An unusual blunt force trauma pattern and mechanism to the cranial vault: Investigation of an atypical infant homicide

Carolyn V. Isaac*, Jered B. Cornelison, Clara J. Devota, Brandy L. Shattuck, Rudolph J. Castellani

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


This case report presents an unusual fracture pattern in the cranium of a four-month-old infant indicative of child abuse. Upon postmortem examination, the infant presented with numerous bilateral linear cranial fractures running perpendicular to the sagittal suture with depressed and curvilinear fractures apparent on the supra-auricular surfaces of the cranium. Histological evidence indicates multiple traumatic events to the cranium. In addition, the stair-step pattern of a parietal fracture may represent multiple contiguous fractures from repeated loading of the head at different times with variation of the focal points of compressive force. Additionally, the left humerus, left radius, and left ulna have healing metaphyseal fractures, and the left ulna also has an antemortem diaphyseal fracture which resulted in the distal metaphysis being rotated 45 degrees medially. Integration of autopsy, anthropological, and neuropathological reports for this case suggest multiple inflicted injury episodes with a repeated atypical mechanism(s) to the cranial vault of the infant. During investigative interviews, the caretaker admitted to squeezing the infant's head and neck on multiple occasions to quiet the child. This reported abusive mechanism is consistent with the pattern of symmetric cranial fractures and soft tissue injuries indicating asphyxiation. This case report provides forensic investigators with a potential trauma mechanism to explore in cases when a similar pattern of cranial trauma is observed and highlights the need for greater research on fracture propagation and fracture healing in the infant cranium.

Original languageEnglish (US)
Pages (from-to)315-326
Number of pages12
JournalJournal of Forensic Sciences
Issue number1
StatePublished - Jan 2023


  • abusive head trauma
  • asphyxiation
  • child abuse
  • classic metaphyseal lesions
  • forensic anthropology
  • forensic pathology
  • inflicted injury
  • metaphyseal fractures
  • non-accidental injury
  • skull fracture

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Genetics


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