Purpose
It is well recognised that acute rib fractures are easily missed on chest radiographs,
but that those which are healing are more easily detected.
Accepted UK policy for imaging in suspected non-accidental injury (NAI) includes follow-up 3-view chest radiographs two weeks after the initial skeletal survey,
to aid detection of any rib fractures.
If follow-up radiographs are not obtained,
for example in infants who present to the hospital already dead or who die in the two week interval period following an initial skeletal survey,
then...
Methods and Materials
This was a prospective study.
Between September 2008 and October 2010,
26 children underwent initial skeletal surveyimaging perthe recommendations of the 2008 jointRCR/RCPCH working group document,
for either alleged or suspectedNAI.Included in the study group were childrenclassified initially as "sudden unexpected death of an infant" (SUDI),
as it is policy within the Province of Northern Irelandto manage the latter group of patientsas suspected NAI victimsuntil pathology proves otherwise.
All of the children either presented to hospital dead or died in the two week interval period...
Results
There were 16 male and 10 female children.
Age range was 1 day - 4 years.
None of the children included in the study population had any clinicalor radiographic evidence of a bone dysplasia or metabolic abnormality.No other fractures were seen onthe skeletal surveys.Five children (19%) were found to have rib fractures on the CT images,that could not be seen on chest radiographs.
The number of fractures detected by CT varied from 5 - 20.
Individual case historieswhere rib fractures were detected on the CT...
Conclusion
Discussion
The thoracic cagein infants and young children is inherently plastic,
meaning rib fractures are uncommon in this age group; it takes significant force to fracture the ribs of a healthy infant skeleton.
It is possible to fracture anywhere along the length of the rib arc,
as a result of severe accidental (figure 1)or non-accidental trauma,
though when present in a child less than 3 years of age,such fractures arehighly predictive ofNAI.
It takes less force to fracture a rib,
which is abnormal as a...
References
Anilkumar A et al.The role of the follow-up chest radiograph in suspected non-accidental injury.
Pediatr Radiol 2006;36:216-218
Betz P et al.
Rib fractures in children - resuscitation or child abuse? Int J Leg Med 1994;106:215-218
Bilo RAC,
Robben SGF,
van Rijn RR.
Forensic aspects of paediatric fractures.
Differentiating accidental trauma from child abuse (2010),
Springer-Verlag,
Berlin
Bulloch B et al.
Cause and clinical characteristics of rib fractures in infants.
Pediatr 2000;150:e48
Bush CM et al.
Pediatric injuries from cardiopulmonary resuscitation.
Ann Emerg Med 1996;28:40-44
Dolinak...
Personal Information
Dr Anne Paterson,
Consultant Paediatric Radiologist,
Department of Radiology,
Royal Belfast Hospital for Sick Children,
180 Falls Raod,
Belfast BT12 6BE,
UK
Dr Peter Ingram,
Consultant Forensic Pathologist,
State Pathology Department,
Royal Victoria Hospital,
Grosvenor Road,
Belfast BT12 6BA,
UK
Dr Claire Thornton,
Consultant Paediatric Pathologist,
Department of Pathology,
Royal Victoria Hospital,
Grosvenor Road,
Belfast BT12 6BA,
UK
Correspondence to Dr Paterson.
Email:
[email protected]