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It is well recognised in non-accidental injury that some children who have rib fractures on x ray have no external evidence of these.
Over the years of providing opinions on the radiology in non-accidental injury I, and several of my colleagues, have come across a small number of children who have been presented to health visitors or doctors with a parental complaint of feeling a “clicking” sensation or “grating” feeling in the rib cage or, indeed, even hearing an odd “click”. This has been ignored as a sign of rib fractures. The children have then been sent home only to return with further injury.
I write to draw the attention of paediatricians to this sign in the hope that it will assist in recognising this for what it is.
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