Bilateral First Rib Fractures in Blunt Trauma Patients: A Retrospective Study

Introduction: Unilateral fracture of the first rib frequently led to severe complications such as brachial plexus or major vascular injury. Bilateral first rib fracture (BFRF) is very rare. We aimed to study the incidence, mechanism of injury, management, and outcome of BFRF in blunt trauma patients in a community-based hospital. Methods: Data of all blunt trauma patients who were admitted to our institution with (BFRF from December 2014 through January 2017) were retrospectively collected. Data included demography, mechanism of injury, severity of the injury, associated injuries, management, and outcome. Results: During the study period, 4779 patients with blunt trauma were included in the trauma registry and 12 (0.25%) patients had BFRF. The mean age of standard deviation (SD) was 29 (8.3) years. Seven (58.3%) patients were involved in road traffic collisions and 5 (41.7%) patients fell from more than 3 m height. The most commonly associated thoracic injury was lung contusions in 8 (66.7%) patients. The median (range) Glasgow Coma Score on admission was 15 (14-15) and Injury Severity Score (SD) was 19 (10.5). Length of hospital stay mean (SD) was 6.8 (6.4) days. No patients died in the study. Conclusions: BFRF is a rare entity in blunt trauma patients caused by high-energy trauma. Major vascular or brachial plexus injuries in patients with BFRF are much less than those reported in the medical literature on unilateral first rib fractures. Associated injuries are the main cause of trauma-related morbidity rather than the direct effect of BFRF.