Isolated bilateral first rib fracture associated with congenital cervical block vertebra – A case report

Abstract

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.2–4 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.