Bilateral first rib fractures with pseudoarthrosis in a weight lifter

Abstract

collimation; Somatom Sensation 16: Siemens; Germany) of the thoracic inlet was carried for further delineation of the fractures. The NCCT study revealed clear fracture lines with well defined and sclerotic margins with no evidence of callus formation suggestive of pseudoarthrosis. Axial oblique reconstructions along the plane of the first ribs were carried out which enabled complete delineation of the fracture lines (Figure 2A). A volume rendered image further enhanced the anatomical delineation of the rib cage clearly outlining the fractures ( Figure 2B). An isotope bone scan (99m Tc MDP) confirmed focally increased uptake of the tracer (Rt > Lt) in the first ribs corresponding to the fracture sites (Figure 3). The fracture on the right side appeared to correspond to the site of subclavian sulcus whereas the fracture on the left side was situated posterior to the expected location of the subclavian sulcus. Based on the imaging findings, diagnosis of stress fracture of bilateral first rib with pseudoarthrosis was made. He has been advised rest and is being managed conservatively. DISCUSSIONThe first rib is protected on all sides by the shoulder girdle and its musculature. Hence first rib fracture due to direct trauma is

Acute Thoracic Outlet Syndrome Associated with Congenital Pseudarthrosis of the First Rib

“…Hence, first rib fractures because of direct trauma are rare, and isolated bilateral first rib fractures are extremely rare. A fracture of the first rib usually occurs at the thinnest and weakest anatomical point, which is at the groove for the subclavian artery, also known as the subclavian sulcus 2 . When injury in this region occurs, the rib is subject to opposing forces of scalenus anterior and serratus anterior 2 .…”

“…A fracture of the first rib usually occurs at the thinnest and weakest anatomical point, which is at the groove for the subclavian artery, also known as the subclavian sulcus 2 . When injury in this region occurs, the rib is subject to opposing forces of scalenus anterior and serratus anterior 2 . A quick and unexpected forceful contraction of the scalene muscle can result in a fracture of the first rib at the subclavian sulcus 2 .…”

“…An MRI confirmed the first rib injury and increased inflammation to the brachial plexus with hypertrophy and inflammation of all 3 scalene muscles (Figs. 2…”

Case Report: Surgical Management of Painful Manubriosternal Pseudoarthrosis

“…Bilateral first rib fractures and pseudoarthrosis and callus formation at the thoracic inlet were described by Satija et al ( 5 ) in a 17-year-old boy who complained of pain after 18 months of regular weight lifting. Zabaleta et al ( 4 ) describe sternal pseudoarthrosis in a rugby player who similarly underwent debridement and titanium osteosynthesis.…”

“…Motor vehicle crashes and chest seat belt restraints are the most common causes of sternal fracture. Reports of sternal injury among sportsmen and athletes are less common, however, with fracture resulting from non-contact trauma described in only sporadic cases in the literature (1)(2)(3)(4)(5).…”