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Published on: April 11, 2012
Retrospective evaluation and dating of non-accidental rib fractures in infants
T R Sanchez1, H Nguyen, W Palacios
1Division of Pediatric Radiology, UC Davis Children's Hospital, Sacramento, CA 95835, USA. thomas.sanchez@ucdmc.ucdavis.edu
Insights
Healing rib fractures in infants follow a predictable pattern. Measuring callous thickness on radiographs provides an objective method for estimating the age of infant rib fractures.
Area of Science:
- Pediatric Radiology
- Skeletal Imaging
- Forensic Radiology
Background:
- Accurate dating of rib fractures in infants is crucial for child abuse investigations.
- Current methods for estimating fracture age are often subjective.
- Radiographic assessment of callous formation is a potential objective measure.
Purpose of the Study:
- To describe the sequential radiographic appearance of healing rib fractures in infants.
- To establish an objective method for dating rib fractures by measuring callous thickness.
Main Methods:
- Retrospective analysis of digital skeletal surveys in infants (<12 months).
- Assessment of six radiological features (callous and fracture stages).
- Exclusion of infants with osteogenesis imperfecta, vitamin D deficiency, or skeletal dysplasia.
Main Results:
- Twenty-three rib fractures in 16 infants were analyzed.
- Callous formation progresses predictably, advancing one stage every 2 weeks.
- Callous thickness peaks around stage 4 and remodels by stage 6.
Conclusions:
- Infant rib fractures exhibit a predictable healing pattern.
- Measuring callous thickness offers an objective approach for radiologists to estimate fracture age.
Aim:
To describe the sequential appearance of healing rib fractures on initial and follow-up radiographs using published guidelines in approximating the age of rib fractures in infants with the aim of establishing a more objective method of dating rib fractures by measuring the thickness of the callous formation.
Materials And Methods:
This was a retrospective analysis of initial and follow-up digital skeletal surveys of infants less than 12 months of age performed between January 2008 and January 2012 at the University of California Davis Children's Hospital. Six radiological features of rib fractures evaluating the appearance of the callous formation (C stage) and fracture line (F stage) were assessed. Patients with osteogenesis imperfecta, known vitamin D deficiency, and skeletal or metabolic dysplasia were not included in the study. Thereafter, callous thickness was measured and recorded for each stage.
Results:
Sixteen infants (age range 1-11 months, seven males and nine females) with 23 rib fractures were analysed. The thickness of the callous formation follows a predictable pattern advancing one stage after a 2-week follow-up with progressive callous thickening starting from stage 2, peaks at around stage 4, and then tapers and remodels until it almost disappears when the fracture is healed at stage 6.
Conclusion:
It appears that rib fractures in infants follow a predictable pattern of healing. Measuring the thickness of the callous formation is a more objective way of guiding the radiologist in estimating the age of the fracture.
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