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Rib fractures in children--resuscitation or child abuse?

P Betz1, E Liebhardt

  • 1Department of Legal Medicine, University of Munich, Germany.

International Journal of Legal Medicine
|January 1, 1994
PubMed
Summary

Rib fractures in children during resuscitation are rare, especially in dorsal areas. Dorsal rib fractures in infants without bone disease strongly suggest physical child abuse, not resuscitation errors.

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Area of Science:

  • Forensic Pathology
  • Pediatric Traumatology

Background:

  • Resuscitation efforts, including closed-chest massage, can lead to thoracic injuries.
  • Distinguishing between resuscitation-induced fractures and those from physical abuse is critical in pediatric autopsies.

Purpose of the Study:

  • To analyze autopsy findings of rib fractures in children.
  • To differentiate between fractures caused by resuscitation and those indicative of child abuse.

Main Methods:

  • Retrospective review of autopsy reports from 233 children (5 days to 7 years).
  • Categorization of deaths into non-traumatic (190 cases) and traumatic (43 cases).
  • Analysis of resuscitation attempts and fracture locations.

Main Results:

  • Only 2 of 190 non-traumatic deaths with resuscitation showed bilateral midclavicular rib fractures.
  • 15 of 43 traumatic deaths had fractures, primarily of the posterior ribs.
  • Physicians caused resuscitation injuries more frequently than non-medical persons.

Conclusions:

  • Ventral thoracic fractures can occur during resuscitation.
  • Dorsal rib fractures in infants without metabolic bone disease are strong indicators of physical child abuse.
  • Findings refute claims of inexpert resuscitation causing rib fractures.

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