Abnormalities of the rib growth plate and the periphysis of previously healthy infants and toddlers dying suddenly and unexpectedly

Abstract

AimsHistological examination of the rib is of critical value in perinatal pathology and points to the health of the child preceding death. The rib is considered ideal because it is the most rapidly growing long bone in infants and demonstrates growth arrest at onset of the insult. We aimed to identify: (1) changes in the perichondrial ring (PR) in the rib of infants and children up to 16 months of age dying suddenly at our institution and (2) any association with presence of histological changes of vitamin D deficiency (VDD)/metabolic bone disease (MBD) in the growth plate.MethodsRetrospective review of the PR histology and comparison with the presence or absence of histological features of VDD in the growth plate of 167 cases. The cases were anonymised and divided in six age/gender categories.ResultsPeriphyseal abnormalities were only seen in 38% of the cases; of whom 33% had established and 67% had mild changes. Only 14.5% of cases with established histological appearance of VDD at the growth plate had significant PR abnormality; of whom majority (83%) were ≤3 months of age and none ≥9 months old, reflecting a temporal relation with birth and beyond the perinatal period.ConclusionThe histological changes in the PR are significantly associated with histological changes of VDD/MBD at the rib growth plate with an OR of 3.04.

Infantile rib fractures at autopsy: a marker of antemortem trauma or resuscitation artefact?

“…However, skeletal surveys do not always identify fractures, and in some cases (particularly in young infants in the presence of metabolic growth plate changes) abnormalities of cartilage in the growth plate and/or in the periphysis may add confounding factors. [2][3][4] In other instances, fractures are only identified at autopsy.…”

“…By carefully studying the histological findings in bone the age of fractures can be determined within a time-frame, 8 as well as the presence or absence of metabolic changes that may have a bearing on the nature of the force needed to produce a fracture. [2][3][4] James 9 makes a hugely important contribution to the body of knowledge in this area. In his series he studied histologically 22 rib fractures from seven infants, in whomafter thorough medical and legal enquiriesthere was no suspicion of intentionally inflicted injury, and it was felt likely that the anterior to anterolateral rib fractures identified would have been consequent upon resuscitation efforts.…”