Pediatr Radiol (2010) 40:1848–1849 DOI 10.1007/s00247-010-1818-0

BOOK REVIEW

R. A. C. Bilo, S. G. F. Robben, R. R. van Rijn (eds): Forensic aspects of pediatric fractures: differentiating accidental trauma from child abuse (1st edn) Springer-Verlag Berlin Heidelberg, 2010. Hardcover 210 pp, English, ISBN-10 3540787151, ISBN-13 978-3540787150, US $139 Brent H. Adler

Published online: 24 August 2010 # Springer-Verlag 2010

Any physician who has had the experience of testifying in a child abuse case, either for the prosecution or the defense, feels slightly naked in front of a judge or jury. That same feeling should occur to one early in the original patient encounter when one is asked how an injury could have come about. While it would be nice to pretend that because we have medical degrees and fellowships and certifications we can therefore know the truth about what we see, we must admit that we can only give probabilities and inferences. While we can identify pathology and translate the shadows of the patient into a diagnosis, the full truth might not be as simple as it appears. Most of the time there is a narrow range of possible diagnoses or etiologies. As in any modern scientific field, in order to be an authority on a subject we have to return to the journals and the books constantly and understand that yesterday’s truth, whether about the dating of fractures or the incidence of rib fractures in premature infants, is changed and refined by new investigation. We have been lucky to have Dr. Paul Kleinman’s 1998 seminal book “Diagnostic Imaging of Child Abuse.” It is among the most important books in any pediatric or radiology library. I am happy to say we now have some new authors who are building on this invaluable contribution. And the understanding of the truth moves on. Type of book “Forensic Aspects of Pediatric Fractures,” edited by Bilo, Robben and van Rijn, is a fantastic new book that is a prime example of contemporary scientific B. H. Adler (*) Department of Radiology, Nationwide Children’s Hospital, 700 Children’s Drive, Room A1010, Columbus, OH 43206, USA e-mail: [email protected]

literature. The book aggregates recent and contemporary research on all manners of skeletal injury. It combs together hard statistics and contemporary imaging and actual clinical work through careful collection of contemporary literature. The result is a slim and pithy text that will no doubt be the standard by which future child abuse texts will be judged. Contents Drs. Bilo, Robben and van Rijn follow a fairly rigid outline to build this text. Each chapter is divided into sections, a particular bone or body part is described, the injuries it might suffer from accident and abuse are defined, statistics with regard to common or specific abuse injuries are further described, healing and sequelae are presented and differential diagnoses are further explored. Each section is crammed with references and it is rare that an observation or axiom is not supported by one or two direct references. The value of that resource alone cannot be overstated. Strengths The book is very well illustrated with contemporary radiographs, CT scans and MRIs. There are also a dozen wonderful illustrations of mechanisms of injury and at least that many pathology photographs of injury and postmortem dissection. The captions that accompany them are concise, and each chapter includes several key-point boxes that reinforce the text. The text is outstanding. If the question has been asked about a particular injury you will be hard-pressed not to find the answer here. For example, the debate regarding the specificity of sternum fractures and child abuse is given three paragraphs and six references. The authors outline the evidence, even defining which age groups were included in which papers and what conclusions were established and which were simply conjecture. Of course not all or even most of the information in this book is new, but it is presented in a

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manner that reinforces old understandings with new research and supporting investigations. One should not be surprised to revise one’s own understanding of specific injuries after just a few minutes with this book. Of particular interest in this book is a fine chapter on normal variants of congenital and acquired disorders that nicely illustrates many of the important mimics of abuse. The rickets controversy is given a good explanation and the authors comment on the old and new literature. The authors remind the reader that the overlap of fractures commonly seen in abuse and those reported in rickets poses less of a problem than one might imagine. And this opinion is backed up by studies published in the last few months in this very journal. Weaknesses The text is confined to fractures. While fractures are the most common radiographic finding in child abuse, the subject of neurological injury, specifically brain injury, and its evaluation is a source of endless debate. Because of this omission one will have to return to older texts and recent journals for better understanding. That said, the book is very dense. The amount of information imparted per page is tremendous. The prose style of quoting study after study, reiterating the study design, and restating study findings

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becomes difficult to read after few minutes. But if the book is approached by topic one feels very well informed after reading even a small section. I would have liked the inclusion of some orthopedic perspective on some of the injuries described. This might be very helpful in the sections that deal with extremity fractures and with fracture dating. Our orthopedic surgeons are well versed in the healing of bones and they hold a wealth of information on the mechanisms of many of these fractures. Recommendation This book is a wonderful addition to any radiology or pediatric library. I believe it is an outstanding resource for radiologists, pediatricians and child abuse experts. I dare say that prosecutors and defense lawyers will find this an invaluable book for preparing their cases. Students and researchers might find this a very helpful resource as well. I would also like to thank the authors for introducing me to a new word. Anamnesis is a term for a remembrance or for medical history and in this instance history of the events leading to the injury in question. Overall grade Excellent.