December 15, 2010

Non Accidental Injury (NAI): Rib Fractures

Chest radiography of a 2-month-old baby shows multiple bilateral rib fractures of different ages. Left-sided rib fractures (arrowheads) appear to have callus formation, while the right sided fractures (arrows) do not. Note right pleural effusion/thickening laterally.

Facts: Fractures in Non-Accidental Injury
  • Second most common findings of child abuse after dermatologic findings (bruises, contusions, burns)
  • Can be found throughout the whole skeleton
  • Likely multiple and in diverse stages of healing
  • Long bone fractures are the most common, with some oblique or spiral components (due to torsion force)
  • Classic metaphyseal lesions and location of fractures (ie, posterior rib fractures) are more suspicious than others
Rib Fractures in NAI
  • Highly predictive of child abuse in the absence of accidental trauma or certain skeletal diseases (e.g., osteogenesis imperfecta), particularly in children less than 3 years old
  • In children with rib fractures, the likelihood of NAI decreases with increasing age
  • Multiple rib fractures are more likely to be seen in NAI compared to single fractures
  • NAI is more likely in the presence of posterior rib fracture
Our case: non-accidental injury with multiple rib fractures in various stages of healing

Medina LS, Applegate KE, Blackmore CC. Evidence-based Imaging in Pediatrics, 2010.

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