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Rib fractures after chest physiotherapy for bronchiolitis or pneumonia in infants
Martin Chalumeau1, Laurence Foix-L'Helias, Pierre Scheinmann
1Service de Pneumolgie et d'Allergologie Pédiatriques, Hôpital Necker-Enfants Malades, Paris, France.
Insights
Chest physiotherapy (CPT) is a newly identified, rare cause of infant rib fractures. This finding is crucial for accurate diagnosis, especially when fractures are the sole indicator of potential child abuse.
Area of Science:
- Pediatrics
- Radiology
- Neonatal Care
Background:
- Infant rib fractures are typically linked to abuse, trauma, or medical procedures like CPR.
- Other causes include bone fragility, birth trauma, and severe coughing.
Purpose of the Study:
- To identify and report chest physiotherapy (CPT) as a novel cause of rib fractures in infants.
- To highlight the clinical significance of CPT-induced fractures in differential diagnosis.
Main Methods:
- Retrospective review of infants with rib fractures following CPT.
- Study conducted over 4 years across three university hospitals in Paris.
- Inclusion criteria: infants treated with CPT for bronchiolitis or pneumonia.
Main Results:
- Five infant boys (median age 3 months) presented with rib fractures post-CPT.
- No alternative causes for fractures were identified in these cases.
- Fractures (median 4, range 1-5) were unilateral in most cases, affecting ribs 3-8.
- Estimated prevalence of CPT-related fractures at 1 in 1,000 infants hospitalized for respiratory illness.
Conclusions:
- Chest physiotherapy (CPT) is a rare but potential cause of infant rib fractures.
- CPT-induced fractures require consideration in infants, particularly when ruling out non-accidental trauma.
- Awareness of this association aids in accurate diagnosis and prevents misinterpretation of findings.
Background:
The reported causes of rib fractures in infants are: child abuse, accidental injury, cardiopulmonary resuscitation, bone fragility, birth trauma and severe cough.
Objective:
To report chest physiotherapy (CPT) as a new cause of rib fractures in five infants.
Materials And Methods:
We retrospectively identified all infants with rib fractures after CPT for bronchiolitis or pneumonia over a 4-year period in two paediatric and one paediatric radiology units in three university hospitals in Paris.
Results:
Five boys were identified. Their median age was 3 months. None had any other potential cause of rib fractures. The indication for CPT was bronchiolitis in four cases and pneumonia in one. The median number of rib fractures was four (range 1-5). Fractures were located between the 3rd and 8th ribs; they were lateral in four patients and posterior in one; they were unilateral in four patients and bilateral in one. Evolution was favourable in all cases. The prevalence of rib fractures after CPT during the study period was estimated at 1 in 1,000 infants hospitalised for bronchiolitis or pneumonia.
Conclusions:
CPT should be considered a potential, but very rare cause of rib fractures in infants. It can be of clinical relevance when rib fractures are the only feature suggestive of child abuse.