[Morphology and diagnostics of mechanisms of chest bone fractures and their use in analyzing forensic medicine results]. / Morfologia i diagnostyka mechanizmów zlaman kosci klatki piersiowej -- wykorzystanie w opiniowaniu sadowo-lekarskim.

The study presents the analysis of 343 available protocols of autopsy results. In the reviewed material, the authors noted that of 343 autopsies performed in 2005, in 92 cases, rib fractures were present. The study reviews the articles on the morphology and determination of the mechanism of rib fracturing. The authors describe the majority of factors that influence the type of fracture, as well as the current views on the possibility of applying the knowledge of morphology and mechanisms of rib fracturing in opinionating in traffic accidents, injuries inflicted to victims of assault and battery, in interpreting autopsy findings in victims of falls from high altitude or crushing by heavy objects, as well as in differentiating between primary and secondary injuries, and also identifying fractures occurring during resuscitation. Fractures in children are presented separately. The authors also analyze the issue of establishing the sequence of fractures.

Does cardiopulmonary resuscitation cause rib fractures in children? A systematic review.

BACKGROUND: There is a diagnostic dilemma when a child presents with rib fractures after cardiopulmonary resuscitation (CPR) where child abuse is suspected as the cause of collapse. We have performed a systematic review to establish the evidence base for the following questions: (i) Does cardiopulmonary resuscitation cause rib fractures in children? (ii) If so, what are the frequency and characteristics of these fractures that may help to distinguish them from rib fractures caused by physical abuse? METHODS: We performed a literature search of original articles, references, textbooks, and conference abstracts, published in any language from 1950 to 1 October 2005. Articles were identified from ASSIA, Caredata, Medline, Ovid Medline in Process, ChildData, CINAHL, Embase, ISI Proceedings, SIGLE, Science Citation Index, Social Science Citation Index, and TRIP databases. We included all studies that addressed rib fractures and CPR in children less than 18 years, and excluded review articles, expert opinion, consensus guidelines, and studies that were significantly methodologically flawed on critical appraisal. Each study underwent two independent reviews (with a third review if there was disagreement). Each reviewer used standardized criteria for study definition, data extraction, and critical appraisal, to determine the quality of the study and to establish if it met the inclusion criteria of this systematic review. FINDINGS: Of the 427 studies reviewed, 6 were included: 1 case control, 4 cross-sectional, and 1 case series. These represent data on 923 children who underwent CPR. Three children sustained rib fractures as a result of resuscitation; all three of these had fractures that were anterior (two mid-clavicular and one costo-chondral). We did not find any child in the literature who had a posterior rib fracture due to CPR. Resuscitation was performed variably by both medical and non-medical personnel. CONCLUSION: Rib fractures after cardiopulmonary resuscitation are rare. When they do occur, they are anterior and may be multiple. As the studies performed to date did not use the most sensitive techniques for detecting rib fractures, further prospective studies of children would be valuable to provide additional clarification on this question.