Rib fractures in 31 abused infants: postmortem radiologic-histopathologic study
P K Kleinman1, S C Marks, K Nimkin
1Department of Radiology, University of Massachusetts Medical Center, Worcester 01655, USA.
Insights
Rib fractures are common in abused infants, but detection depends on imaging technique. High-detail skeletal radiography is recommended for identifying these fractures in both live and deceased infants.
Area of Science:
- Pediatric Radiology
- Forensic Pathology
- Skeletal Trauma
Background:
- Rib fractures are a common injury in abusive head trauma.
- Understanding the mechanisms of injury and radiographic visualization is crucial for diagnosis.
Purpose of the Study:
- To investigate the morphologic characteristics of rib arc and costochondral junction fractures in abused infants.
- To determine factors influencing radiographic detection of these fractures.
- To gain insight into the injury mechanisms.
Main Methods:
- Study included 31 infants (average age 3 months) with inflicted skeletal injuries.
- High-detail skeletal surveys (pre/postmortem) and specimen radiography were used.
- Histologic analysis was performed and correlated with radiologic findings.
Main Results:
- 84 of 165 total fractures (51%) involved the ribs.
- Only 30% of rib fractures were detected via skeletal survey.
- Lateral/anterior arc fractures impacted the inner cortex; CCJ fractures involved the osteochondral interface.
Conclusions:
- Acute and healing rib fractures are frequent in infants with inflicted injuries.
- Fracture detection is highly dependent on the imaging technique used.
- High-detail skeletal radiography is valuable for identifying these injuries.
Purpose:
To examine the morphologic alterations of fractures of the lateral and anterior rib arcs and costochondral junction (CCJ) to better understand the factors that influence radiographic visualization and to gain insight into the mechanism of injury in rib fractures of abused infants.
Materials And Methods:
Thirty-one infants (average age, 3 months) who died with inflicted skeletal injuries were studied with high-detail, pre- or postmortem skeletal surveys, or both, and radiography of specimens, with histologic analysis. The distribution and number of fractures were determined for each technique, and dating was performed on the basis of radiographic and histologic criteria. The radiologic features were correlated with the pathologic findings in comparable histologic sections.
Results:
Of 165 fractures, 84 (51%) involved the ribs. Only 30 rib fractures (36%) were visible with skeletal survey examination. Lateral and anterior arc fractures tended to impact along the inner cortex of the rib. CCJ fractures tended to involve the inner aspect of the osteochondral interface with an associated osseous fragment.
Conclusion:
Acute and healing rib fractures are common in infants who died with inflicted injury; detection is technique-dependent. Use of high-detail skeletal radiography to identify these injuries in live and deceased infants appears justified.
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