Medical experts in the trial of a man accused of murdering a Tauranga toddler say her injuries were similar to those that would be sustained falling several storeys or in a high-speed crash.
Adrian Colin Clancy, who is on trial in the Rotorua High Court, has denied murdering 17-month-old Sadie-Leigh Gardner in Tauranga on March 27, 2019.
The Crown has alleged Clancy violently assaulted Sadie-Leigh while she was in his sole care. His jury trial began on March 15.
Sadie-Leigh was admitted to Tauranga Hospital in a critical condition on March 27 before being transferred to Starship Children's Hospital in Auckland. She died two days later.
In an opening address earlier this week, Crown prosecutor Richard Jenson described her several head and brain injuries, neck and shoulder, as unsurvivable.
The Crown alleges a frustrated or angry Clancy caused the injuries then sought help from a neighbour after realising the toddler was unconscious. The defence says there is no Crown evidence linking Clancy to the alleged assault.
Dr Russell Metcalfe, a paediatric radiologist at Starship Children's Hospital and part of the hospital's child protection unit, gave evidence for the Crown yesterday.
Metcalfe said a CT scan done at Tauranga Hospital on March 27 revealed a right parietal skull fracture with boggy haematomas overlying the fracture.
The toddler also had significant retinal haemorrhages to her eyes, and the post-mortem examination also revealed bleeding behind the optic nerve. She was unable to see.
There were significant bilateral subdural brain bleeds and a fracture to the right side of her skull just below the right ear.
He said this was a "very recent" fracture that led to her traumatic brain injury, and something likely to have happened between a few minutes and a few hours before the child was admitted to the hospital.
Metcalfe said a post-mortem MRI of the cervical spine two days later showed extensive swelling and pressure in Sadie-Leigh's brain resulting in the cerebellum being pushed about 7cm down into the spinal cord.
There were also injuries to the cervical spinal ligaments in her neck and bilateral subdural blood collections in the brain and severe damage to the brain itself, he said.
With the absence of any history of trauma, the neck injury was, in his opinion, the result of abusive trauma to the neck inflicted with a severe level of force, he said.
There was also a left scapula (shoulder blade) fracture that could have happened less than seven to 10 days prior to Sadie-Leigh's admission to Starship hospital.
However, Metcalfe said the injury could easily have happened at the same time as the head injury given no evidence of healing nor evidence produced of any previous trauma.
This type of injury was "rare" and it was more likely to have been caused by a kick, a punch or the child being hit with something.
"This is what has happened, in my experience," he said.
There was a mid-line shift of the toddler's brain from the right to the left side and the brain was "very swollen and squished to the left".
He said from the amount of blood collecting outside the toddler's brain, it confirmed to him this injury was a "very recent" event.
Metcalfe said these types of catastrophic injuries would fit with someone involved in a "high-speed five-car pile-up" on the Auckland motorway with other people dead at the scene.
"But here we don't have that [clinical] history of trauma," he said.
By the time Sadie-Leigh was transferred to Starship, parts of her brain were already dead or dying and there was nothing they could do to save her.
During cross-examination by Clancy's lawyer Kerry Tustin, Metcalfe agreed he could not say who caused the injuries nor the exact timing of when the injuries were caused.
But he said the skull fracture and intensive bleeding in the brain were recent events and it would have been immediately apparent that Sadie-Leigh was critically unwell on impact.
In his vast experience dealing with hundreds of child abuse injury cases, Sadie-Leigh's injuries were the result of "abusive blunt force trauma" impact.
Forensic pathologist Dr Kilak Keesha conducted the post-mortem examination on Sadie-Leigh the day after she died, in Auckland.
Keesha said the cause of death was "blunt force trauma with one major blow" causing catastrophic injuries which led to the severe extensive brain injury.
He said there was clear evidence of widespread swelling of the brain which led to the brain shifting to the left and partially down into the spinal cord.
He said the impacts of the injury which was the result of a "direct high impact" should have been apparent straight away to others.
Under questioning by Crown prosecutor Richard Jenson, Keesha said the scapula fracture that Sadie-Leigh suffered was "extremely rare".
"We usually only see these in high impact motor-vehicle accidents or someone falling from several storeys."
He said there was also usually other associated fractures such as fractures to the arms or ribs but they were absent in this case.
This was a direct high impact injury which would have happened anywhere from days to weeks before death," Keesha said.
The trial continues on March 22.