Case No. EWFC-47

19.Professor Mangham identified metaphyseal fractures of the distal left tibia. Although there are two fractures identified, one which is medial and one lateral, they would have been caused at the same time and can be considered as one. They were sustained no less than 2 days and no more than about 5 before O died.20.There is no evidence that O suffered from any medical condition that would have predisposed him to suffering fractures. According to Dr. Rylance only rare genetic causes, each of which could possibly have become apparent if O had lived longer and could not be excluded by the comprehensive investigation already undertaken remain as remote possibilities.21.Dr. Rylance stated that metaphyseal fractures of long bones in children of O’s age do not occur in normal handling. Nor, in his view, do they occur with rough handling when that description applies to a carer who is appropriately concerned about the wellbeing of a baby. Evidence of this, he says is available by way of exclusion in that such fractures do not tend to be discovered incidentally in routine x rays of children who are screened for reasons other than suspected injury.22.Fractures do not seem to occur when doctors handle children confidently (sometimes interpreted by parents as more robust than they would be themselves), or when children get their legs or arms stuck through furniture such as cot bars.23.The mechanism for these sorts of fractures is a pull combined with a twist or torsion. Dr. Rylance said that a sudden jerking movement has been described to him by two perpetrators. He said that the perpetrator would be aware that the force they had used would be excessive, but not that they had caused a fracture.24.The child is likely to cry but the duration cannot be predicted. A non perpetrator would likely not have realised that anything had happened because babies behave as usual after such fractures – a baby of this age would cry so frequently anyway anything amiss would not necessarily be noticed.