{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T17:14:43Z","timestamp":1778087683103,"version":"3.51.4"},"reference-count":15,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2022,6,10]],"date-time":"2022-06-10T00:00:00Z","timestamp":1654819200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Patients with osteogenesis imperfecta (OI) are at an increased risk of pathological rib fractures even if there is no history of trauma. Early and accurate identification of such fractures are crucial for appropriate management. We present a case of a child with OI type 3 with multiple rib fractures who presented with transient cyanosis and increased work of breathing without a history of significant trauma. The patient\u2019s chest radiographs were reported to have a single, new right posterior fourth rib fracture and an old, healing anterior fourth rib fracture. A point-of-care ultrasound performed by the attending pediatric emergency physician revealed additional findings of refracture over the old right anterior fourth rib fracture site and a new left posterior third rib fracture. These findings of multiple and bilateral rib fractures better account for the patient\u2019s initial presentation. This case highlights the added advantages of ultrasound over conventional chest radiographs in the evaluation and diagnosis of a tachypnoeic pediatric patient with underlying metabolic bone disease and a complex skeletal structure with multiple pathological rib fractures but no chest tenderness.<\/jats:p>","DOI":"10.3390\/children9060864","type":"journal-article","created":{"date-parts":[[2022,6,10]],"date-time":"2022-06-10T10:25:12Z","timestamp":1654856712000},"page":"864","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Point of Care Ultrasound Identification of Multiple Rib Fractures in a Pediatric Patient with Osteogenesis Imperfecta Type 3"],"prefix":"10.3390","volume":"9","author":[{"given":"Samuel Enci","family":"Quek","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, KK Women\u2019s and Children\u2019s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vigil","family":"James","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, KK Women\u2019s and Children\u2019s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leodivica","family":"Castillo","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, KK Women\u2019s and Children\u2019s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore"},{"name":"Duke-National University of Singapore Medical School, 8 College Road, Singapore 169857, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronald Ming Ren","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, KK Women\u2019s and Children\u2019s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore"},{"name":"Duke-National University of Singapore Medical School, 8 College Road, Singapore 169857, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9879-0594","authenticated-orcid":false,"given":"Gene Yong-Kwang","family":"Ong","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, KK Women\u2019s and Children\u2019s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore"},{"name":"Duke-National University of Singapore Medical School, 8 College Road, Singapore 169857, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,6,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1097\/PEC.0000000000000911","article-title":"Prevalence of Abuse among Young Children with Rib Fractures: A Systematic Review","volume":"35","author":"Paine","year":"2019","journal-title":"Pediatr. 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Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1016\/j.cjtee.2016.04.010","article-title":"Comparison of ultrasonography and radiography in diagnosis of rib fractures","volume":"20","author":"Pishbin","year":"2017","journal-title":"Chin. J. Traumatol."},{"key":"ref_9","first-page":"55","article-title":"Comparison of Ultrasonography and Radiography in Detection of Thoracic Bone Fractures; a Systematic Review and Meta-Analysis","volume":"4","author":"Yousefifard","year":"2016","journal-title":"Emergency"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1007\/s00247-008-1026-3","article-title":"Children\u2019s exposure to diagnostic medical radiation and cancer risk: Epidemiologic and dosimetric considerations","volume":"39","author":"Linet","year":"2009","journal-title":"Pediatr. 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Int."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"S149","DOI":"10.1016\/j.otsr.2015.05.010","article-title":"Pathological fractures in children: Diagnosis and treatment options","volume":"102","author":"Canavese","year":"2016","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1007\/s00247-021-05247-w","article-title":"Multi-modality imaging characteristics of costochondral fractures, a highly specific rib fracture for child abuse","volume":"52","author":"Gensel","year":"2022","journal-title":"Pediatr. 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