Non-traumatic fracture of the first rib

A 25 year old man presented to the emergency department complaining of severe left chest pain associated with shortness of breath on waking. A chest radiograph showed a fracture of the left first rib. There was no history of recent direct trauma, although a minor injury to the left shoulder girdle had occurred three weeks earlier. Current theories on mechanism of injury in fractures of the first rib with both direct and indirect trauma are discussed and clinical management outlined.