Rib fractures frequently are encountered in abused infants and commonly occur in the posterior rib arcs. Fractures occurring near the costovertebral articulations are rarely identified radiographically in the acute phase, and callus formation usually is the first indication of injury. To assess the factors influencing the visibility of fractures near the costovertebral articulations in abused infants, 103 posterior rib fractures occurring in 16 abused infants were studied radiologically. The plain radiologic studies were correlated with the pathologic findings in 15 ribs from four patients. The limited visibility of fractures relates to (1) the frequent superimposition of the transverse process over the rib fracture site, (2) a fracture line that crosses at an obliquity to the radiographic beam, and (3) nondisplacement of rib fragments due to preservation of the posterior periosteum. Fresh fractures invisible on a frontal projection are clearly defined when the rib is viewed axially with postmortem radiography. These findings explain the reported superior sensitivity of radionuclide bone scans vs radiography in the identification of fresh posterior rib fractures. A knowledge of the factors influencing the visibility of these important injuries is useful in planning an appropriate diagnostic evaluation in cases of suspected infant abuse.

译文

:受虐婴儿经常会发生肋骨骨折,通常发生在肋骨后弧。肋骨关节附近发生的骨折很少在急性期通过影像学方法鉴定出来,而愈伤组织的形成通常是损伤的第一个迹象。为了评估影响受虐婴儿肋骨关节附近骨折可见性的因素,对16名受虐婴儿中发生的103处后肋骨骨折进行了放射学研究。普通的放射学检查结果与4例患者的15条肋骨的病理结果相关。骨折的可见性有限涉及(1)横突在肋骨骨折部位上的频繁叠加,(2)一条与放射线束倾斜的交叉点的骨折线,以及(3)由于保存而导致的肋骨碎片未移位骨膜后部。当用尸体放射照相法轴向观察肋骨时,可以清楚地定义在额骨上看不见的新鲜骨折。这些发现解释了放射性核素骨扫描相对于放射照相在鉴定新鲜的后肋骨骨折方面具有更高的敏感性。了解影响这些重要伤害的可见性的因素对于计划在怀疑婴儿虐待的情况下进行适当的诊断评估很有帮助。

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