Costochondral junction fractures and intra-abdominal trauma in non-accidental injury (child abuse)

Abstract

Rib fractures are a common skeletal manifestation of non-accidental injury (NAI) in infants and young children and are generally considered to be highly specific for abuse. There are, however, relatively few descriptions of fractures involving the costochondral junctions in NAI. We present three children (two boys, one girl; 7, 18, and 36 months of age) with anterior rib fractures which involved the sixth to ninth costochondral junctions. The fractures were bilateral in two children and symmetrical in one. They had appearances analogous to ’bucket handle' metaphyseal fractures of long bones. They were difficult to visualise and healed with minimal callus formation. These fractures were associated with major abdominal visceral injuries, which in themselves carry a significant morbidity and mortality. The importance of recognising such fractures is highlighted.