Rib fractures in 31 abused infants: postmortem radiologic-histopathologic study

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.