1ST RIB FRACTURES - INCIDENCE OF VASCULAR INJURY AND INDICATIONS FOR ANGIOGRAPHY

Abstract

Patients [45] with 49 fractures of the 1st rib caused by blunt trauma underwent arteriography. The fractures were classified as posterior, lateral or anterior and as nondisplaced, minimally displaced or significantly displaced. Seven patients (14%) had serious vascular injuries: 5 had posterior injuries, 1 had a lateral fracture and 1 had an anterior fracture. All 7 had significantly displaced fractures. Vascular injury can result from a violent lever mechanism in which the posterior portion of the rib is displaced downward and the anterior portion is forced upward, pinching the contents of the thoracic outlet against the clavicle. Four patients with subclavian artery injury had clinical evidence of arterial insufficiency. Brachial plexus injury occurred only in association with vascular injury. Only displaced 1st rib fractures, and particularly posterior displaced fractures, result in vascular injury. Arteriography is indicated if there is an absent pulse, a brachial plexus injury or a displaced 1st rib fracture. Using these criteria, all vascular injuries would be detected. The majority (78%) of the patients with 1st rib fractures could be managed without arteriography.