Bilateral first rib fractures with multi-organ complications: A case report and literature review

Bilateral first rib fractures are rare. This article presented the diagnosis and treatment of a case of bilateral first rib fractures with multi-organ complications and discussed the injury mechanism.

A 15-year-old girl fell off a motorcycle. She complained of right neck root pain and right upper limb weakness. The myodynamia of the right upper limb was grade 0, and the sensation disappeared below the level of the elbow joint. The computed tomography (CT) showed bilateral first rib fractures and transverse process fracture of the 6th cervical vertebra. Chest CT revealed a massive hemothorax in the right thoracic cavity, and head magnetic resonance imaging showed bilateral cerebellar infarction. Cervical computed tomography angiography (CTA) revealed a lumen occlusion at the origin of the right subclavian artery. The patient underwent an emergency thoracoscopy, and a re-examination of chest CT indicated that no obvious pleural effusion was found after the hemothorax was cleared. The patient underwent right subclavian arteriography and interventional endovascular thrombolysis, and the right subclavicular artery was patency postoperative. Bilateral first rib fractures and cerebellar infarction were treated conservatively. The brachial plexus injury did not show any signs of recovery after conservative treatment, and she was recommended to be transferred to a superior hospital for surgical treatment.

The injury mechanism of bilateral first rib fractures with multi-organ complications was closely related to the initial factor of the right neck root colliding with a bulge on the ground. We believe that the fractures occur as a result of a combination including a high energy trauma from direct impact and a low-energy mechanism from violent muscle contraction caused by neck hyperextension. This case report was helpful for clinicians to understand bilateral first rib fractures and their complications.