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  • Brief Communication
  • Open Access

Accidental tramline bruising and rib fractures

International Journal of Emergency Medicine20103:145

  • Received: 8 September 2009
  • Accepted: 23 November 2009
  • Published:


  • Public Health
  • Internal Medicine
  • Emergency Medicine
  • Average Child
  • Linear Pattern


A 37-year-old, 85-kg man fell from his bicycle landing on his left chest. Fractures of the fifth and sixth ribs were diagnosed clinically and with ultrasound. Bruising developed after a few days in a tramline, linear pattern with three stripes outlining the affected ribs (Figs. 1 and 2). Tramline bruising is often presumed to be caused by blows with a linear implement and in children would be considered suggestive of maltreatment [1].
Fig. 1
Fig. 1

Three stripes outlining the affected ribs

Fig. 2
Fig. 2

Ultrasound visualisation of fractures

In this case it is hypothesised that the linearity was caused by compression of the skin against the tarmac by the ribs from within, rather than by compression by a rod from without. It is likely that such a mechanism requires a body mass substantially greater than the average child’s, so although this case demonstrates that linear bruising in an adult is not pathognomonic of a blow with a rod-like implement, in children it will raise suspicion of maltreatment.


Authors’ Affiliations

Accident and Emergency Medicine Academic Unit, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong


  1. National Collaborating Centre for Women’s and Children’s Health (2009) When to suspect child maltreatment. RCOG Press, LondonGoogle Scholar


© Springer-Verlag London Ltd 2010