Skull fracture (NAI)

Last revised by Mostafa Elfeky on 10 Oct 2023

Skull fractures in non-accidental injury are the result of abusive impact head trauma. However, not all skull fractures in children are the result of abuse. Accidental head injury may result in a skull fracture and it is important for the radiologist to understand what features make a non-accidental etiology more likely.

Parietal skull fractures are the commonest type of fracture in children. A simple parietal skull fracture is no more likely to be non-accidental than accidental. If the history fits the injury and there is no evidence of other injuries or social concerns, it is unlikely that further child-protection workup is required. 

Simple skull fractures are single, linear fractures with no depression and no sutural diastasis.

In cases where there are stellate, complex or depressed fractures, or where there is sutural diastasis, there is an increased likelihood that the injury is the result of an inflicted non-accidental injury (abusive head trauma).

See further detail in Neuroimaging in NAI.

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