Skull fracture patterns from head impact in infants

As submitted by the proposer: The U.S. Department of Health and Human Services estimates that approximately 686,000 children were victims of abuse and neglect during 2012. The highest percentage of these children are between birth and 3 years of age, and are more likely to experience a recurrence of maltreatment if the abuse is not identified. To confound matters, accidental falls are the leading cause of non-fatal injury in infants less than one year old and also the most common explanation given by caretakers suspected of abuse. Thus, distinguishing a truthful history of a fall from a false one proves to be a difficult but important task for a clinician, and for the legal system. Skull fracture is a common finding for both accidental falls and abusive injuries, but it is unknown how to distinguish fracture from accidental or abusive scenarios. There is an urgent need for careful biomechanical investigations to determine characteristics of trauma that lead to specific skull fracture patterns in infants. The purpose of this proposal is to develop and validate a computational toolset for predicting skull fracture patterns in infants. Our goal is to be able to use the toolset to identify skull fracture patterns from common low height accidental falls in infants, and to evaluate the effect of head impact direction, impact energy, and skull thickness on skull fracture patterns. We propose to accomplish this by first quantifying the mechanical and fracture properties of infant cranial bone. Then, we will use this data to develop a high-fidelity computational model for predicting crack propagation and fracture patterns in infant cranial bone. The validity of the model will be evaluated against experimental fracture pattern studies, existing cadaver studies, and well-witnessed accidental falls in infants. Successful completion of these objectives will provide the medical and legal communities with empirical data and a computational toolset that can be used to improve medical and judicial accuracy in child abuse cases. Note: This project contains a research and/or development component, as defined in applicable law. ca/ncf