Rib fractures: Accidental or nonaccidental

Introduction: We report an incidental discovery of multiple rib fractures in a wheezing child without a history of an injury or the presence of metabolic bone disease. As a result, the child was evaluated for the presence of non­ accidental trauma. Case Report: An 11­month­ old African­American child was brought to the emergency department by his father with a 2­ day history of fever, cough and breathing difficulty. After receiving nebulizer treatments, the child was still wheezing. A chest X­ray was obtained which showed bilateral fractures of the ribs. No history of trauma was provided. Given the radiographic findings, Child Protective Services was contacted and a report of child abuse was made. Conclusion: Child abuse is a complex phenomenon. Any skeletal injury in young children can be due to abuse. Rib fractures are uncommon in the pliable chest of a child. When discovered, however, they raise the suspicion of a non­accidental trauma. They are often uncovered during the assessment of children who present to the emergency department for unrelated reasons. The physician's ability to differentiate accidental from non­accidental trauma may depend on gathered information. This report emphasized the importance to evaluate for non­accidental trauma after the finding of bilateral rib fractures on a chest X­ray. Non­accidental trauma should be considered when there is evidence of injury without a history of trauma.