Fractures of the rib head in abused infants

P. K. Kleinman, S. C. Marks, M. R. Spevak, J. M. Richmond

Research output: Contribution to journalArticlepeer-review

61 Scopus citations


Fractures of the posterior ribs are well-recognized sequelae of infant abuse. Previous reports have indicated a prediction for fracture near the costotransverse process. This study expands the spectrum to include fractures involving the rib head. The radiologic and histologic features are described, and the mechanism of injury of this lesion is examined. In situ and specimen radiography, followed by histopathologic examination, was performed in 78 ribs removed from seven abused infants who died with posterior rib fractures. Computed tomography of the intact posterior thorax was performed in two of these infants. Fifty posterior rib fractures were identified; 29 involved the rib head. Frontal radiography was insensitive in identifying these fractures, clearly revealing injury only when periosteal reaction was present (four of 29 cases). Axial specimen radiography delineated the fractures in all cases. In the two infants studied, CT depicted five of 19 fractures visible only with axial specimen radiography. The morphologic features of these fractures further support the concept that most fractures in abused infants occur by means of indirect forces and are consistent with anteroposterior manual thoracic compression during assaults.

Original languageEnglish (US)
Pages (from-to)119-123
Number of pages5
Issue number1
StatePublished - Jan 1 1992
Externally publishedYes


  • Children, injuries
  • Children, skeletal system
  • Infants, injuries
  • Radiography, in infants and children
  • Ribs, fractures

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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