As a society, we have come a long way when it comes to safeguarding our children. The first legislation aimed at legally protecting children from abuse was not enacted until 1889 (although a succession of laws on child labour, the so-called Factory Acts, were passed in the UK throughout the 19th century). Before that, the maxim ‘spare the rod, spoil the child’ was reverently adhered to by many parents, with the full support of the state and, most importantly in past times, the Church
Now we have the Children Act 1989 which gives every child the right to protection from abuse and exploitation and the right to inquiries to safeguard their welfare. Although this and other measures are essential for protecting the most vulnerable members of our society, there have been several high-profile cases of parents being falsely accused of child abuse following the discovery of long bone fractures.
On the flip side, the media has reported several recent cases of social services and/or police failing to adequately protect children who have suffered horrendous physical abuse. In all paediatric long bone fracture cases, expert orthopaedic witnesses can provide the evidence needed to confirm abuse caused the long bone fracture or the injury resulted from another source such as an accident or underlying bone disease.
What is the role of expert evidence in paediatric fracture cases?
The evidence of an expert witness is essential if the cause of a child’s fracture is uncertain and/or contentious. Radiography provides data on both suspected non‐accidental injury and suspected bone dysplasia and the British Society of Paediatric Radiology has established agreed standards for skeletal imaging in suspected non‐accidental injury. An expert witness will ensure that these and other professional guidelines are rigidly adhered to. Experienced expert witnesses also have contacts to secure high-quality imagery that is not always available to the diagnosing physician.
Bone disease can also be picked up in lab diagnosis using three routes: biochemical analysis of collagen species, mutation analysis of RNA, and mutation analysis of DNA (the first two methods require skin fibroblasts so would only be used in cases where surgical treatment was required). The ability to critically examine lab results and compare them with radiography imagery and medical history is a crucial part of an expert witness’s role and their findings can provide invaluable information to assist the court.