![]() It would not, however, be likely to cause a general vulnerability across whole skull. It is a biologically plausible mechanism where if a fracture is present and further force is applied, the fracture may extend. Similarly, for the same reasons as described above, a skull will be more vulnerable to further fracture where it already has a fracture.A complex fracture can include: separation of fracture margins, a branching fracture, an occipital bone fracture or bilateral fractures.More complex fractures are more commonly seen in context of NAI but it is the case that the appearance of a fracture is likely to relate to the degree of force rather than allowing us to make a distinction between accidental and NAI. The commonest fracture in accidental and NAI is a simple linear fracture.Everyday clinical experience leads us to believe force won’t be trivial and is probably significant force. Not all infants who have trauma are sent for scans so we don’t even know the true number of fractures. ![]() In terms of degree of force, we do not know what is required.A traumatised fissure describes a fissure that has experienced some kind of injury/force that then looks like a fracture on a scan.Usually we only see one or two fissures on a skull more would be unusual but again the true number is unknown as they are not looked for.If that is the case then widening of a pre-existing fissure could look just the same as a primary fracture. ![]()
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