High-impact trauma causing multiple posteromedial rib fractures in a child

Rib fractures in infants and young children are highly associated with abuse. Fractures near the costovertebral junction carry a high specificity for abuse because they result from excessive anteroposterior chest compression, which may occur when a child is gripped around the chest by an assailant. This results in excessive levering of the posterior ribs over the vertebral transverse processes, resulting in fracture near the rib head or neck. We describe a young child involved in a motor vehicle collision who sustained multiple posteromedial and lateral rib fractures in identical locations to those found in victims of abuse. In this patient, the presumed mechanism of injury was consistent with the compressive forces that cause rib fractures in abused infants and young children. This case illustrates how a high-impact traumatic event may cause rib fractures that would otherwise point strongly to abuse.