Fracture of right first rib. Note the apical pleural cap along the medial apical pleura. The first rib is situated deep to the clavicle and so fracture of the first rib means serious injury to the thorax and is usually associated with disruption of the clavicle. Hence, fractures of the first rib must be evaluated throughly for associated trauma to apex of lung, subclavian vessels, neurologic sequalae, tracheoesophageal fistula, pleurisy, cardiac alterations, aneurysm of aortic arch and additional fractures.
Indirect force owing to a sudden strong contracture of the scalenus anterior muscle combined with traction on the arm and on the serratus anterior muscle can produce a fracture about the subclavius sulcus of the rib.1 Hyperextension of the neck produce a similar abnormality. This type of injury is obviously not associated with the above mentioned complications.
-This boy had a fight in school, someone pulled both his arms behind his back and threw him on the ground. He did not