Refining Management of Pediatric First Rib Fractures Without Major Trauma

First rib fractures in children are typically associated with high-impact trauma; atraumatic etiologies remain understudied. The purpose of this study is to evaluate the presentation and management of pediatric first rib fractures in the absence of major trauma.

This is a retrospective study of pediatric patients diagnosed with first rib fractures between 2000 and 2023 at a quaternary, free-standing children's hospital. Exclusion criteria were major trauma and baseline bone disease.

We identified 24 patients with a first rib fracture in the absence of major trauma (median age 14 years, 15 (63 %) male). The most common etiologies were exercise (n = 8, 33 %), stretching (n = 5, 21 %), and idiopathic (n = 5, 21 %). The most common symptom was ipsilateral shoulder pain (n = 16, 67 %). Chest x-ray (CXR) was the primary diagnosis modality (n = 16, 67 %). Seven patients (29 %) had chest computed tomography (CT), which showed no additional pathology. Most first rib fractures were non-displaced (n = 19, 79 %), and the rest were minimally displaced (n = 5, 21 %). Most patients did not have any associated injuries (n = 20, 83 %), 3 patients (13 %) had additional rib fractures, and one patient (4 %) had concurrent pneumonia. All patients were managed non-operatively; 12 patients (50 %) were seen for follow-up with repeat radiological imaging, primarily CXR. Most patients had appropriate healing on initial follow-up; one patient had delayed healing on initial CXR, requiring follow-up CT.

Pediatric first rib fractures can occur in the absence of major trauma; extensive additional workup is often not necessary. Diagnostic chest computed tomography did not yield clinically significant findings beyond x-ray.