Bilateral first rib anomalous articulations with pseudarthroses mimicking healing fractures in an infant with abusive head injury

Melissa A. Pasquale-Styles, Christian M. Crowder, Jeannette Fridie, Sarah S. Milla

Research output: Contribution to journalArticlepeer-review

Abstract

Bilateral symmetric bone nodules were observed in the anterolateral first ribs of an infant with shaking injuries at autopsy. The location prompted diagnostic considerations of healing fractures versus anomalous articulations with pseudarthroses. The forensic pathologist worked with forensic anthropologists and pediatric radiologists to evaluate autopsy findings and compare premortem and postmortem X-rays. Gross examination of the bones by the pathologist and anthropologists confirmed bilateral, callus-like bone nodules in first-rib locations associated with pseudarthroses. Histologic examination of one of the bones further showed features most consistent with pseudarthrosis, not a healing fracture. Radiologists then compared multiple premortem and postmortem radiographs that showed no remodeling of the bone over a 2-week interval between the time of injury and death, which would be unexpected for a healing fracture in an infant. This multidisciplinary approach resulted in the appropriate diagnosis of pseudarthroses due to anomalous articulations, an uncommon finding in forensic pathology.

Original languageEnglish (US)
Pages (from-to)1668-1671
Number of pages4
JournalJournal of Forensic Sciences
Volume59
Issue number6
DOIs
StatePublished - Nov 1 2014
Externally publishedYes

Keywords

  • Forensic anthropology
  • Forensic pathology
  • Forensic science
  • Histology
  • Nonunion
  • Pediatric radiology
  • Pseudarthrosis
  • Rib fracture

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Genetics

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