Rib Fractures in Infants Due to Cardiopulmonary Resuscitation Efforts

@article{Dolinak2007RibFI,
  title={Rib Fractures in Infants Due to Cardiopulmonary Resuscitation Efforts},
  author={David Dolinak},
  journal={The American Journal of Forensic Medicine and Pathology},
  year={2007},
  volume={28},
  pages={107-110}
}
  • D. Dolinak
  • Published 1 June 2007
  • Medicine
  • The American Journal of Forensic Medicine and Pathology
Although it is widely known that adults may sustain fractures of the anterior and/or lateral aspects of the ribs due to cardiopulmonary resuscitation (CPR) efforts, relatively little is written about the generation of CPR-related rib fractures in the infant age range. In a series of 70 consecutive autopsies in infants ranging in age from 2 weeks to 8 months, with no history or indications of injury, the parietal pleura of the thoracic cage was stripped and the ribs carefully examined for… 

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A scheme was developed to describe the location of rib head fractures observed in a pediatric forensic population, which uses three anatomical landmarks, terminus (tip), tubercle, and cost overtebral articular surface to divide the rib head into two subregions, costovertebral and costotransverse.

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References

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Rib fractures in children — resuscitation or child abuse?

It was observed that relevant injuries due to resuscitation are caused much more frequently or almost exclusively by physicians than by non-medical persons and refutes any possible claims that rib fractures were caused by inexpert resuscitation in a panic-like reaction.

Fractures of the rib head in abused infants.

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.

Child abuse, cardiopulmonary resuscitation, and rib fractures.

In spite of prolonged resuscitation performed with variable degrees of skill, no fractures could be attributed to CPR; on the other hand, rib fractures occurred frequently in abused children.

Cause and Clinical Characteristics of Rib Fractures in Infants

Most rib fractures in infants are caused by child abuse, although much less common, rib fractures can also occur after serious accidental injuries, birth trauma, or secondary to bone fragility.

Rib fractures in 31 abused infants: postmortem radiologic-histopathologic study.

Acute and healing rib fractures are common in infants who died with inflicted injury; detection is technique-dependent and use of high-detail skeletal radiography to identify these injuries in live and deceased infants appears justified.

Cardiopulmonary resuscitation and rib fractures in infants. A postmortem radiologic-pathologic study.

Cardiopulmonary resuscitation is unlikely to cause rib fractures in infants and rib fractures visible at autopsy or with postmortem radiographs after cardiopul pulmonary resuscitation are unlikely.

Mechanical factors associated with posterior rib fractures: laboratory and case studies

The mechanical factors associated with posterior rib fractures were explored to explore when these fractures occur in accidental situations, they require massive forces that entail similar mechanics to those occurring in abusive settings.

Fractures in Premature Infants

Their clinical history, the radiographic appearance, and laboratory data suggest that most of the infants may have suffered from bone loss associated with low intake of calcium and phosphorus, and improving the metabolic status and removing the risk factors prevented further fractures and led to good healing.

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Fractures and Rickets in Very Low Birth Weight Infants: Conservative Management and Outcome

It is suggested that VLBW infants with F/R can be managed “conservatively,” with emphasis on nutritional intake to achieve weight gain, and skeletal maturation as indicated by the development of ossification centers at the wrists was directly related to weight gain.