Rib fractures in infants: Red alert! The clinical features, investigationsand child protection outcomes

Objective: To examine clinical features, investigation methods and outcomes of infants with rib fractures. Methodology: All infants aged 2 years or younger who presented over a 5-yea r period with documented rib fractures were identified from the medical rec ords database of a tertiary referral paediatric hospital and data collected by retrospective chart review. Additional data regarding notifications and placements were obtained from the Department of Families Youth and Communi ty Care, Queensland. Results: Rib fractures were attributed to child abuse in 15 of 18 infants i dentified. The initial presentation in the abused infants was most often as a result of intracranial pathology and limb fractures. In four cases the r ib fractures were incidental findings when abuse had not been suspected. Bo ne scintigraphy revealed eight previously undetected rib injuries in four c ases. In three cases of abuse, the rib fractures were an isolated finding. Three of the infants with inflicted rib injuries were discharged home. In o ne such infant a significant re-injury occurred. Three returned home with i mplicated adults no longer in residence, and nine spent a mean period of 12 months in foster care. Conclusions: Rib fractures in infancy are usually caused by severe physical abuse. Accidental rib fractures are rare in infants and result from massiv e trauma. Rib fractures, multiple or single, may occur in isolation in abus ed infants. The implications of such injuries must be recognized to ensure appropriate, safe and consistent child protection outcomes. Bone scintigrap hy is more sensitive than radiographs in the detection of acute rib fractur es and should be performed in all cases of suspected infant abuse.