Inadvertent Clavicular Fractures Caused by ‘Chiropractic’ Manipulations in an Infant: An Unusual Form of Pseudoabuse
Sperry, K
Associate medical examiner, Fulton County Medical Examiner's Office, Atlanta, GA.

Pfalzgraf, R
Pathologist, Hamilton County Coroner's Office, Cincinnati, OH.


Abstract
A nine-month-old child was found unresponsive in his crib, five hours after his last feeding. At autopsy, there were no external or internal signs of abuse or neglect, and a few visceral pleural and epicardial petechiae were consistent with the sudden infant death syndrome (SIDS). However, postmortem total body radiographs revealed healing, symmetrical clavicular fractures and a healing left medial humeral epicondyle fracture. The parents had no explanation for these injuries and denied causing any harm to the child. The location and nature of the fractures strongly suggested abusive origin, and the case was reported to the police and the district attorney's office as child abuse. During the investigation, information from the parents indicated that the child had undergone “chiropractic” manipulations by an unlicensed therapist, between three and four weeks prior to death, to correct supposed “shoulder dislocations.” This time interval correlated with the histologic age of the injuries, and the history explained their unusual bilateral location and appearance. The parents were exonerated of abuse charges, and the death was ascribed to SIDS.

Keywords:
autopsy, child abuse, chiropractic manipulation, clavicular fracture, folk remedy, forensic pathologist, forensic science, inadvertent trauma, pathology and biology, postmortem, postmortem examinations, radiograph, trauma

Paper ID: JFS355901211

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Author Sperry K, Pfalzgraf R Title Inadvertent Clavicular Fractures Caused by ‘Chiropractic’ Manipulations in an Infant: An Unusual Form of Pseudoabuse Symposium , Committee on