Rib fractures in non-accidental injury are a relatively common mode of presentation in inflicted non-accidental injury.
In the context of a child with normal bones, rib fractures are always concerning for non-accidental injury 1 and appropriate clinical assessment should be made. This will usually result in the involvement of the child protection team.
Pathology
Rib fractures can be separated based on their location:
posterior
lateral
costochondral junction
Posterior rib fractures are most commonly the result of an anteroposterior compressive force and in the context of an inflicted injury, this is most commonly the result of adult hand squeezing the child's chest.
Lateral and costochondral junction fractures may also be the result of a compressive force, especially if bilateral. However, they may also be the result of a direct blow.
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