Bilateral Fracture of the First Rib

Joshi, S. G.; Panday, SR; Gb, Parulkar; Sen, P. K.

doi:10.1302/0301-620x.47b2.283

Cited by 12 publications

(5 citation statements)

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“…This produces a bending strain resulting in a fracture just behind the attachment of the scalene medius muscle. A similar probable mechanism was suggested by Joshi SG et al 15 5 patients were injured due to a fall on an outstretched hand (4 from RTA and 1 from height) resulting in fracture at shaft of first rib on the same side. This was probably due to strong violent contraction of the scalenus anterior muscle combined with traction on the arm.…”

Section: Discussionsupporting

confidence: 63%

A prospective randomized trial on trauma thoracic cage with rib fracture especially first rib fracture and associated complications

Kochar

Singh

2016

Int Surg J

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Background: Thoracic cage is an osseocartilaginous cavity which not only protects and supports vital organs but also has dynamic role in mechanism of respiration. The aim was to study the mechanism of first rib fracture, incidence and complications of first rib and other ribs' fracture and their sequelae. Methods: A prospective randomized trial was conducted on 300 patients of trauma thoracic cage having rib fracture with or without associated injuries at NIMS Medical College and Hospital, Jaipur, Rajasthan, India from April 2013 to March 2016. All patients were examined on a fixed protocol (age, sex, mode of injury, vital status, number and site of rib fracture) with associated injury and complications. Results: Maximum patients (including males and females both) with first and other rib fractures were in the age group of 11-30 years. The most common mode of trauma was roads traffic accident (RTA). First rib fractured at shaft by indirect trauma mostly. Commonly reported chest, abdomen and associated injury complications were haemothorax, haemoperitoneum and head injury respectively. Most of the patients were treated conservatively except 1% patients who required thoracotomy. Conclusions: Most common cause of chest trauma with rib fracture was RTA and first rib fracture was indirect trauma. The most common cause of mortality was an associated head injury. Kochar MP et al. Int Surg J. 2016 Aug;3(3):1278-1282 International Surgery Journal | July-September 2016 | Vol 3 | Issue 3 Page 1279 contraction of scalene and sternocleidomastoid muscle, thus fracture of first rib. Most commonly fractured ribs are 4 th -9 th , generally at the weakest area (posterior angle). Flail/stove in chest lead to paradoxical respiratory movements. Lower ribs fracture is usually associated with injury to diaphragm and abdominal organs (fracture of left lower ribs-spleen, right lower ribs-liver, floating ribs-renal injuries). Chest injuries are usually life threatening, either on their own or in conjunction with other system injuries. Ribs fracture may compromise ventilation, pain can cause respiratory splinting and fragments of fractured ribs can act as penetrating objects. Threats to life are; Keywords ImmediatePneumothorax, haemothorax, flail/ stove in chest, airway injuries, pericardial tamponade. PotentialPulmonary contusion, oesophageal/ aortic/ tracheobronchial/ myocardial injuries, rupture of diaphragm.The aim was to study rib fractures' mechanism, incidence and complications especially the first rib and their sequelae. METHODSThe study was conducted on 300 patients at NIMS Medical College and Hospital, Jaipur, Rajasthan, India, during the period April 2013 to March 2016, admitted in various departments mainly department of orthopaedics and neurosurgery having rib fracture with or without associated injuries. All patients were examined on a fixed protocol (age, sex, mode of injury, vital status, number and site of rib fracture) with associated injury and their complications were recorded. All patients underwent routine...

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Section: Discussionsupporting

confidence: 63%

A prospective randomized trial on trauma thoracic cage with rib fracture especially first rib fracture and associated complications

Kochar

Singh

2016

Int Surg J

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“…This is attributed to the unique anatomical characteristic of the first rib. The first rib is a deeply seated structure shielded by the shoulder girdle and its surrounding muscles [3]. Thus first rib fractures (unilateral) are classically caused by high energy trauma resulting in serious damage to mediastinal structures, rupture of the subclavian vessels and trauma to the brachial plexus and minor damage to the clavicle and scapula (as illustrated by the second patient) [2,4].…”

Section: Discussionmentioning

confidence: 99%

“…Indirect injuries have been attributed to violent contractions of juxtacostal muscles such as the scalene and sternocleidomastoid muscles which result in severe bending strain at a relative point of weakness at the first rib such as the subclavian groove [3].…”

Section: Discussionmentioning

confidence: 99%

Bilateral First Rib and Associated Lower Cervical Spine Fractures

Ismail¹,

Looi²,

Hakim³

et al. 2017

MOJOR

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A 20 year-old male motorcyclist crashed and fell backwards hitting his head first (with his helmet on) near the occipital area. At the emergency department, he complained of pain over his lower neck and was found to have tenderness at the lower cervical region and was unable to fully abduct both his upper limbs. No other neurovascular abnormalities or chest injuries were detected.Radiological examination indicated bilateral first rib and C7 transverse process fractures. Both clavicles were intact. A CT scan of the chest showed a small left haemothorax with adjacent lung contusion. No pneumothorax was seen and the right lung field was clear. The heart was of normal size with no pericardial effusion and the main vessels are of normal caliber.The hemothorax was treated conservatively with patient on Philadelphia collar with thoracic extension for two months. At 18 months follow-up, complete healing occurred with no complications noted. Case 2A 46-year old man was involved in a motor vehicle accident (MVA) and sustained fractures of the skull, mandible, and maxilla, both first ribs, left 2 nd and 3 rd ribs, left clavicle and left scapula.A CT scan of the head revealed multiple facial bone fractures and a left temporal extradural hemorrhage while CT scan of the chest showed a left hemothorax and subcutaneous emphysema. A CT scan of the cervical spine confirmed fractures of both first ribs and the left C7 transverse process. MRI of the cervical and brachial plexus area noted a presence of haematoma on the left paraspinal region compressing the upper left brachial plexus, which was not properly visualized.Clinically, the patient had Horner's syndrome and was thus diagnosed with a pre-ganglionic upper brachial plexus lesion (C5, C6, C7).Approximately two months post-trauma, the patient recovered from his injuries but the brachial plexus injury remained.

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“…A similar mechanism is said to be elicited by a sudden unexpected hyperextension of the cervical spine (Joshi et al 1965, Frangakis 1967 ) independent follow-up study of stress fractures which revealed spontaneous bony union and which could not be taken to mean that this was a developmental anomaly.…”

Section: Discussionmentioning

confidence: 98%

“…Isolated fracture of the first rib often occurs without a history of trauma (Alderson 1947), or after a trauma which is rarely linked to the fracture. Therefore, the mechanism of this fracture has been discussed by many authors in the past (Jones 1869, Aitken & Lincoln 1939, Proctor et al 1945, Brook 1959, Joshi et al 1965, Frangakis 1967, Blichert-Toft & Nielsen 1968, Guillermand 1971. Some authors have even doubted the existence of such a fracture, interpreting the finding instead as a developmental anomaly (Bowie & Jacobson 1945).…”

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confidence: 99%