FRACTURES OF THE FIRST RIB IN CHILD-ABUSE

PURPOSE: To evaluate the incidence and specificity of fracture of the first rib as an indicator of child abuse and to determine a mechanism of fracture. MATERIALS AND METHODS: All infants and young children wit h rib fractures who were seen at the radiology department of an academ ic medical center over a 2-year period were identified from the radiol ogy data base. RESULTS: Rib fractures were attributed to child abuse i n 12 of 35 children identified. Apart from a neonate with congenital o steogenesis imperfecta, only three children, all abused, had first-rib fracture, one bilaterally. Two additional children with first-rib fra cture were identified from years prior to the study period. In four ch ildren, first-rib fractures were ''isolated,'' without fractures of ad jacent bones. CONCLUSION: Child abuse should be considered in cases of pediatric rib fracture, particularly fracture of the first rib. Possi ble mechanisms for first-rib fracture include impact force, compressiv e force, and shaking or acute axial load (slamming), which cause an in direct fracture.