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First rib fractures in abused infants: a report of three cases

John D Melville1, James L Lukefahr, Ewell A Clarke

  • 1University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. Melville@uthscsa.edu

Clinical Pediatrics
|December 14, 2011
PubMed

Insights

First rib fractures in infants are difficult to detect on skeletal surveys but strongly indicate physical abuse. A thorough evaluation for child abuse is crucial when these fractures are suspected in infants.

Area of Science:

  • Pediatric Radiology
  • Child Abuse Forensics

Background:

  • First rib fractures are rare in infants.
  • Skeletal surveys are standard for evaluating infant fractures.

Observation:

  • The study details 4 first rib fractures in 3 infants.
  • These fractures were challenging to identify on standard skeletal surveys.

Findings:

  • All identified first rib fractures resulted from physical abuse.
  • No cases of first rib fracture in healthy infants without abuse were found in the literature.

Implications:

  • Diagnosing infant first rib fractures necessitates immediate medical and social evaluation for child abuse.
  • Radiologists and pediatricians should be vigilant for these subtle fractures.

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