Metaphyseal and Rib Fractures in Child Abuse

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Jeremy Tucker, HMS IV Gillian Lieberman, MD Mechanism of fracture Excessive leverage of rib over transverse process consistent with fracture features Classic type 1 lever: Force on ventral portion of rib Fulcrum at articulation between transverse process and rib Loading (pull) on costovertebral articulation Costovertebral ligaments stronger than rib, so mechanical failure over point of fulcrum Kleinman, PK. Diagnostic Imaging of Child Abuse, Second Edition. 1998. 46
Jeremy Tucker, HMS IV Gillian Lieberman, MD •Front to back force with free posterior rib motion •Excessive leverage over costo-transverse process fulcrum •Fractures at maximal points of strain (ventral portion of rib at neck and head, dorsal portion elsewhere) •Studies with rabbits support compression mech. 47
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Metaphyseal and Rib Fractures in Child Abuse

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