Dr Alfredo Walker carried out a post mortem on the 86-year-old on the afternoon she died, concluding that she died from 'compression of the neck associated with facial injuries.'

He found two fractures at the base of her neck and internal bleeding, Sheffield Crown Court heard today, in addition to the bruising and grazes to her cheek, nose and right eye.

Night nurse Thakane Mtetwa, 61, is accused of killing the Dinnington-born pensioner at Maltby's Layden Court Nursing Home last October.
But Jeremy Baker QC, defending, said a second post mortem had explored other explanations for Mrs Skelton's injuries.

"One possible mechanism would be the use of the upper limbs in a headlock hold," said Dr Walker. "The larger areas of the arm or forearm can cause significant internal damage without leaving any signs."

"It is possible to fracture the neck after death but you would not expect the degree of haemorrhage present at the time of my examination.
There must have been a circulation when the injury occured. The injuries were at most a few hours old."

Mr Baker grilled Dr Walker on his testimony. He suggested it was not as cut-and-dried as he had made out to the jury.

"Sometimes people die from being stabbed through the heart and it's pretty obvious what the cause of death is," Mr Baker said in cross examination. "Other times a young baby is found with bleeding around the brain and fractures and it is relatively straight forward that the likelihood is the baby has been shaken."

"But occasionally there are cases where there is no such degree of certainty as to the cause of death. I think this is one of these more difficult cases."

Mr Baker claimed the neck injuries could have been caused by a seizure. When Dr Walker said he knew of no previous examples involving this type of fracture, Mr Baker said: "Just because one doesn't find something in literature, it doesn't mean it hasn't occurred."

He used a second post mortem examination, performed in November by Dr Stephen Leadbeatter, to show that it was not impossible for the various injuries to have happened co-incidentally.

"I don't hold the view that Dr Leadbeatter's opinion here is credible," said Dr Walker.

Mtetwa denies murder. The trial continues on Monday and is expected to last another week.