Case ReportIsolated bilateral first rib fracture associated with congenital cervical block vertebra – A case report
Introduction
Fracture ribs, more frequently the lower ribs, are commonly associated with Chest trauma.1 First rib fracture is uncommon due to its peculiar anatomical location.2 It was first described by Lane (1885). Bilateral fractures of the first ribs are still rarer.2 They are usually associated with severe blunt trauma; although other mechanisms like indirect trauma, sudden contraction of the neck muscles, and stress or fatigue fractures are also been attributed.2, 3, 4
In indirect trauma, first rib fractures due to violent contraction of scalene and sternomastoid muscles.4, 5 The articular processes of the neural arch have been implicated in weight transmission through the cervical spine. The exact relationship of the cervical block vertebra to the fracture ribs is not clear-cut on account of the alteration in the biomechanics.
First rib fracture may be associated with early or late complications, though they are very rare.3, 6, 7 Treatment for isolated first rib fractures is mild analgesia and rest.2 If complications are present, each must be treated accordingly.6 To the best of our knowledge, bilateral fracture of the first rib associated with congenital cervical block vertebra has not been reported previously.
Section snippets
Case report
A 63-year-old male presented following a fall on outstretched hand, complaining of stabbing pain at the base of the neck and both shoulders. There was no history of direct injury to the neck and shoulders.
On examination there was abraded wound in the middle of the fore head. He had tenderness over the scapular region and at the base of neck. There was no obvious deformity or swelling. There were no abnormal neurological or vascular signs or any evidence of head or chest injury. The neck
Discussion
First rib fractures may be isolated or occur in association with other rib fractures3, 5, 6, 8, 9 and are usually located in the area of anatomical weakness (a shallow depression for the subclavian artery).10
All the other ribs are different from the first rib as it is deeply placed and protected on all sides by the shoulder girdle and by the regional musculature. Hence isolated first rib fracture is rare in direct external violence. If this is the cause, there are often other associated
Conclusion
No reported case of bilateral first rib fracture with congenital cervical vertebra has hitherto been available. This paper describes such a case and the probable biomechanics we postulated.
Statement of patient consent
The authors have obtained the patient's informed written consent for print and electronic publication of the case report.
Conflicts of interest
All authors have none to declare.
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Cited by (1)
An exception to every rule; high velocity impact not always required for bilateral 1st rib fractures
2022, Trauma (United Kingdom)