Fractures of the first rib in child abuse

Radiology. 1995 Dec;197(3):763-5. doi: 10.1148/radiology.197.3.7480753.


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 with rib fractures who were seen at the radiology department of an academic medical center over a 2-year period were identified from the radiology data base.

Results: Rib fractures were attributed to child abuse in 12 of 35 children identified. Apart from a neonate with congenital osteogenesis imperfecta, only three children, all abused, had first-rib fracture, one bilaterally. Two additional children with first-rib fracture were identified from years prior to the study period. In four children, first-rib fractures were "isolated," without fractures of adjacent bones.

Conclusion: Child abuse should be considered in cases of pediatric rib fracture, particularly fracture of the first rib. Possible mechanisms for first-rib fracture include impact force, compressive force, and shaking or acute axial load (slamming), which cause an indirect fracture.

MeSH terms

  • Academic Medical Centers
  • Biomechanical Phenomena
  • Bone Diseases, Metabolic / diagnostic imaging
  • Brain Injuries / complications
  • Brain Injuries / diagnosis
  • Child Abuse / diagnosis*
  • Child, Preschool
  • Female
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Male
  • Osteogenesis Imperfecta / diagnostic imaging
  • Radiography
  • Radiology Information Systems
  • Retrospective Studies
  • Rib Fractures / complications
  • Rib Fractures / diagnostic imaging*
  • Sensitivity and Specificity
  • Stress, Mechanical
  • Wounds, Nonpenetrating / diagnostic imaging