Elder abuse-related rib fractures: performance of chest computed tomography in two case reports

Trauma in victims of abuse often exists in various ways, and the characters usually manifest as non-fatal injuries, repetitive occurrence, and the injured parts are relatively hidden. Forensic experts are optimally positioned to raise suspicion for abuse when comprehensively considering a forensic investigation, reviewing imaging, and other multiple factors of geriatric injury victims. However, few experts received formal or informal training in abuse identification. In this article, we discussed two cases of suspected victims of abuse with rib fractures and attempted to determine the location, timing, and directionality of these injuries to raise the index of suspicion for abuse. We present two cases to characterize the radiographic changes of rib fractures in various stages of healing and radiographic findings in elder abuse events. To improve the accuracy of the imaging diagnosis, we collected a series of computed tomography images of rib fractures and compared all computed tomography images of these two victims with these images. We found that the victims presented with repeated rib fractures and with different stages of healing. We strongly suspect these were abuse cases due to the radiographic findings and clinical recordings demonstrated by these cases. We aim to raise awareness of abuse in radiology and forensic medicine to help these victims and reduce such incidents.