Sternal fractures as a manifestation of abusive injury in children.

BACKGROUND: Sternal fractures are rare injuries in children. The rarity of this injury is likely due to both the relative plasticity of the pediatric thorax and to the difficulty in establishing a radiographic diagnosis without dedicated views. Current literature suggests that this injury in young children is highly specific for abusive injury.

HYPOTHESIS: Sternal fractures are not highly specific for abusive injury.

MATERIALS AND METHODS: This was a retrospective radiographic and clinical chart review of all documented sternal fractures over an 11-year period at a large pediatric hospital.

RESULTS: Of 12 children with sternal fractures identified, four were < or = 2 years of age and eight were > or = 3 years of age. The mechanism of injury was suspicious for child abuse in two children. Both of these children were < or = 2 years of age. In one toddler, an unwitnessed injury resulted in extensive initial familial anxiety until abusive injury was excluded.

CONCLUSION: Sternal fractures are unusual injuries, yet they, in themselves, are not highly specific for abusive injury.