Consider rib fractures as a indication of significant impact and trauma! Treat it like a risk factor for other occult injuries.Highly consider abuse in children with rib fractures! May even want to consider extra thoracic injuries.With each rib fracture, mortality rate increased in nearly linear fashion up to 8.23% for 7th rib fractured.Mortality increased from 1.79% without rib fracture to 5.81% with one rib fracture.In kids, mortality odds worsen with each rib fractured.Adult mortality has a steep increase above 6 fractured ribs.Mortality increases in a LINEAR fashion for each fractured rib in children.Rib fractures should be considered a sign of significant, possible multiple, trauma in kids.Children have higher rates of associated head, thoracic, and solid organ injuries with rib fractures compared to adults.Rib fractures are associated with other injuries.Concurrent extra-thoracic fractures where more common in abuse cases.Lack of intrathoracic injury does not rule out abuse!.Accidental injuries cause more intrathoracic injuries, likely due to the mechanisms.Abused children have more rib fractures than accidentally injured children.Ex, Birth Trauma, Rickets, Osteogenesis Imperfecta.

Other etiologies should be considered as well.Most rib fractures in infants are caused by child abuse.The complaint chest wall does not dissipate a force as well, transmitting more of it inward to the underlying organs (see Pulmonary Contusion).It takes a significant force to cause a rib fracture in a child.The thoracic cage is more compliant (more able to deform without fracture) in children.These changes influence risk for fracture with increasing age (particularly elderly patients).Ribs increase in roundness and horizontal angle with increased age.Rib cage increases in size and decreases in kyphosis from birth to teen years.Rib morphology and orientation changes with age.Children have rib fractures less often than adults due to anatomic and structural differences.Anterior-posterior compression (most common).Rib fractures occur by 2 possible mechanisms:.While pulmonary contusions are the the most common intra-thoracic injury, let’s spend a moment contemplating the significance of Rib Fractures. When we think of injury in children, we often immediately consider head trauma (the leading cause of mortality), but let us not overlook thoracic trauma as it is the second leading cause of mortality in children suffering from trauma. Some of these events are unfortunate and accidental (ex, Submersions), while others are sinister and purposeful (ex, Abuse). We know that children are super flexible and that is a good thing! Often kids will bend and won’t break! Unfortunately, there are events that still lead to childhood injuries.

Signs of rib trauma in a toddler