BACKGROUND The presumed mechanism of rib fractures in abuse is violent grasping of the torso causing anterior-posterior chest compression. We hypothesized an asymmetrical distribution of rib fractures in abused infants given the greater incidence of right-hand dominance within the general population. OBJECTIVE The objective of this study was to characterize rib fractures in abused children, particularly sidedness; additionally, we evaluated the sidedness of other abusive skeletal fractures. MATERIALS AND METHODS We reviewed medical records from abused children (0-18 months old) with rib fractures. We also retrospectively reviewed their radiographs to determine characteristics of rib fractures (number, side, rib region, level, acuity) and other skeletal fractures (number, side, location), as well as differences in the distribution of rib and other skeletal fractures. RESULTS A total of 360 rib fractures were identified on 273 individual ribs involving 78 abused children. Sixty-three children (81%) had multiple rib fractures. There was a significantly greater number of left-side rib fractures (67%) than right-side fractures (P<0.001). Fractures were most often identified in the posterior and lateral regions and mid level of the ribcage (Ribs 5 through 8). Fifty-four percent of subjects had other skeletal fractures; these non-rib fractures were also predominantly on the left side (P=0.006). CONCLUSION In our study of abused children, there was a higher incidence of rib fractures in the posterior, lateral and mid-level locations. Additionally, we found a predominance of left-side rib and other skeletal fractures. Further research is needed to understand whether factors such as perpetrator handedness are associated with these unequal distributions of fractures in abused children.

中文翻译：

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受虐儿童肋骨骨折的特征。

背景技术滥用中的肋骨骨折的推测机制是对躯干的猛烈抓握，导致前后胸部受压。考虑到普通人群中右手支配的发生率较高，我们假设受虐婴儿的肋骨骨折分布不对称。目的本研究的目的是表征受虐儿童的肋骨骨折，尤其是侧面。此外，我们评估了其他虐待性骨骼骨折的侧面。材料和方法我们回顾了受虐儿童（0-18个月大）肋骨骨折的医疗记录。我们还回顾了他们的X射线照片，以确定肋骨骨折（数量，侧面，肋骨区域，水平，敏锐度）和其他骨骼骨折（数量，侧面，位置）的特征，以及肋骨和其他骨骼骨折的分布差异。结果在涉及78名受虐儿童的273根肋骨上共发现360处肋骨骨折。六十三名儿童（81％）患有多发性肋骨骨折。左侧肋骨骨折的数量（67％）明显多于右侧骨折（P <0.001）。骨折最常出现在胸腔的后部和外侧区域以及中部水平（肋骨5至8）。54％的受试者患有其他骨骼骨折。这些非肋骨骨折也主要发生在左侧（P = 0.006）。结论在对受虐儿童的研究中，在后，外侧和中层位置肋骨骨折的发生率较高。此外，我们发现左侧肋骨和其他骨骼骨折占优势。