Sternal fractures as a manifestation of abusive injury in children

Abstract

Background. Sternal fractures are rare injuries in children. The rarity of this injury is likely due to both the relative plasticity of the pediatric thorax and to the difficulty in establishing a radiographic diagnosis without dedicated views. Current literature suggests that this injury in young children is highly specific for abusive injury.

Hypothesis. Sternal fractures are not highly specific for abusive injury.

Materials and methods. This was a retrospective radiographic and clinical chart review of all documented sternal fractures over an 11-year period at a large pediatric hospital.

Results. Of 12 children with sternal fractures identified, four were ≤2 years of age and eight were ≥3 years of age. The mechanism of injury was suspicious for child abuse in two children. Both of these children were ≤2 years of age. In one toddler, an unwitnessed injury resulted in extensive initial familial anxiety until abusive injury was excluded.

Conclusion. Sternal fractures are unusual injuries, yet they, in themselves, are not highly specific for abusive injury.