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Fractures of the rib head in abused infants
P K Kleinman1, S C Marks, M R Spevak
1Department of Radiology, University of Massachusetts Medical Center, Worcester 01655.
Insights
Posterior rib fractures in infants, particularly those involving the rib head, are indicators of abuse. Radiography, especially axial specimen radiography, is crucial for diagnosis, revealing injuries often missed by standard frontal views.
Area of Science:
- Pediatric Radiology
- Forensic Pathology
- Child Abuse Detection
Background:
- Posterior rib fractures are recognized indicators of infant abuse.
- Previous studies noted fractures near the costotransverse process.
- This research expands the understanding to include rib head fractures.
Purpose of the Study:
- To describe the radiologic and histologic features of infant rib fractures.
- To examine the mechanism of injury for these posterior rib fractures.
- To evaluate diagnostic imaging modalities for detecting these fractures.
Main Methods:
- Radiographic and histopathologic examination of 78 ribs from seven abused infants.
- In situ and specimen radiography, including axial views.
- Computed tomography (CT) of the thorax in two infants.
Main Results:
- Fifty posterior rib fractures identified; 29 involved the rib head.
- Frontal radiography was insensitive; axial specimen radiography identified all fractures.
- CT depicted some fractures only visible with axial specimen radiography.
Conclusions:
- Rib head fractures are an important spectrum of abusive injuries in infants.
- Axial specimen radiography is superior to frontal radiography for detecting these fractures.
- Fractures are consistent with indirect forces, such as manual thoracic compression during assaults.
Abstract:
Fractures of the posterior ribs are well-recognized sequelae of infant abuse. Previous reports have indicated a predilection for fracture near the costotransverse process. This study expands the spectrum to include fractures involving the rib head. The radiologic and histologic features are described, and the mechanism of injury of this lesion is examined. In situ and specimen radiography, followed by histopathologic examination, was performed in 78 ribs removed from seven abused infants who died with posterior rib fractures. Computed tomography of the intact posterior thorax was performed in two of these infants. Fifty posterior rib fractures were identified; 29 involved the rib head. Frontal radiography was insensitive in identifying these fractures, clearly revealing injury only when periosteal reaction was present (four of 29 cases). Axial specimen radiography delineated the fractures in all cases. In the two infants studied, CT depicted five of 19 fractures visible only with axial specimen radiography. The morphologic features of these fractures further support the concept that most fractures in abused infants occur by means of indirect forces and are consistent with anteroposterior manual thoracic compression during assaults.