Spontaneous fractures of both first ribs.

This fracture has been variously reported as a developmental anomaly, a synchondrosis or a pseudarthrosis, but most authors now regard it as a true fracture. As far as can be ascertained, only 263 cases of isolated fracture of the first rib have been recorded in the literature and only seventeen of these were bilateral. The majority of the recorded cases have been found incidentally during routine radiography of young healthy adults, notably members of the Services (Alderson 1944 and 1947, Etter 1944, Sjogren 1942). Most of the patients have been unable to remember any injury or any symptoms attributable to a fracture, although a few recollect a sudden pain in the neck and shoulder when lifting or straining, followed by discomfort which persists for a few days afterwards. The fracture is usuall ’ symptomless at the time of radiography. Only fifteen cases have been reported with clinical symptoms sufficiently severe for an early radiograph to be taken and even in some of these patients the fracture appears to have been unsuspected before that examination. When the fracture is first diagnosed, the radiographs may show either a simple linear crack in the rib or a pseudarthrosis with widened, irregular, sclerotic opposing surfaces, or the fracture may already be soundly healed with varying degrees of residual thickening of the rib about the fracture site. Alderson (1947) has shown by serial radiographs that non-union or a false joint often follows this fracture although bony union does occur in some. Symptomless established non-union is often found (Hartley 1945). The fracture is almost confined to males, usually under twenty years of age.