Characteristics of rib fractures in young abused children

  • Stevan KrissEmail author
  • Angela Thompson
  • Gina Bertocci
  • Melissa Currie
  • Vesna Martich
Original Article



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.


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.


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).


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.


Child abuse Children Fractures Handedness Infants Radiography Ribs Sidedness 


Compliance with ethical standards

Conflicts of interest



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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Stevan Kriss
    • 1
    • 2
    Email author
  • Angela Thompson
    • 3
  • Gina Bertocci
    • 2
  • Melissa Currie
    • 4
  • Vesna Martich
    • 1
  1. 1.Department of RadiologyNorton Children’s HospitalLouisvilleUSA
  2. 2.Department of Bioengineering, J. B. Speed School of EngineeringUniversity of LouisvilleLouisvilleUSA
  3. 3.Department of Engineering Fundamentals, J. B. Speed School of EngineeringUniversity of LouisvilleLouisvilleUSA
  4. 4.Department of Pediatrics, Kosair Charities Division of Pediatric Forensic MedicineUniversity of Louisville School of MedicineLouisvilleUSA

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