Abstract
Sternal fractures are considered among the most specific signs of child abuse, along with the classical metaphyseal lesions of the long tubular bones and rib fractures, but are less frequently reported in the literature. Most sternal fractures in infants and young children show manubriosternal segmental dislocation/fracture between the manubrium and the body of the sternum. Skeletal survey may not adequately depict sternal lesions due to overlap with the upper extremities or inappropriate radiographic coverage. Lateral images of the spine with the upper limbs elevated are useful for clear sternal visualization, or lateral target imaging of the sternum can be added. Chest Computed Tomography (CT) is excellent in detecting fractures in both the acute and chronic phases. Considering the serious consequences of missing signs of possible abuse, we consider that aggressive use of chest CT is justified in cases where abuse is clinically suspected but not confirmed from radiographs. The 2021 guidelines from the Japan Radiological Society Imaging weakly recommend using chest CT with appropriate dose settings to detect rib fractures in situations of suspected abuse.
