Retrospective evaluation and dating of non-accidental rib fractures in infants

Thomas Ray Sanchez, H. Nguyen, W. Palacios, M. Doherty, Kevin Coulter

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


AIM: To describe the sequential appearance of healing rib fractures on initial and follow-up radiographs using published guidelines in approximating the age of rib fractures in infants with the aim of establishing a more objective method of dating rib fractures by measuring the thickness of the callous formation. MATERIALS AND METHODS: This was a retrospective analysis of initial and follow-up digital skeletal surveys of infants less than 12 months of age performed between January 2008 and January 2012 at the University of California Davis Children's Hospital. Six radiological features of rib fractures evaluating the appearance of the callous formation (C stage) and fracture line (F stage) were assessed. Patients with osteogenesis imperfecta, known vitamin D deficiency, and skeletal or metabolic dysplasia were not included in the study. Thereafter, callous thickness was measured and recorded for each stage. RESULTS: Sixteen infants (age range 1e11 months, seven males and nine females) with 23 rib fractures were analysed. The thickness of the callous formation follows a predictable pattern advancing one stage after a 2-week follow-up with progressive callous thickening starting from stage 2, peaks at around stage 4, and then tapers and remodels until it almost disappears when the fracture is healed at stage 6. CONCLUSION: It appears that rib fractures in infants follow a predictable pattern of healing. Measuring the thickness of the callous formation is a more objective way of guiding the radiologist in estimating the age of the fracture.

Original languageEnglish (US)
JournalClinical Radiology
Issue number8
StatePublished - Aug 2013

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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