Bilateral first rib fractures associated with Horner's syndrome

A Case Series and Literature Review: Isolated Traumatic First Rib Fracture in Athletes

OBJECTIVE

To present a case series of 14 isolated traumatic first rib fractures sustained in sport and review the literature on clinical presentation, mechanism of injury, diagnosis, and management of sport-related traumatic first rib fractures.

DESIGN

We compiled a series of isolated traumatic first rib fractures seen in 2 Division 1-associated sports medicine clinics. We also performed a literature search for additional publications of isolated traumatic first rib fractures in sport.

SETTING

Patients in our case series were all evaluated and treated at 2 tertiary care center sports medicine clinics.

PATIENTS

Patients were those who sustained isolated traumatic first rib fracture during sport.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

None.

RESULTS

None.

CONCLUSIONS

Traumatic fracture of the first rib in sport is certainly not a common diagnosis, but it is likely more widespread than sports medicine providers realize. Considering the diagnosis of first rib fracture for athletes with shoulder pain after trauma is essential for identifying this injury. Although more study is likely needed to make definitive recommendations on treatment and return to play protocols, the case series and literature review presented suggests that rehabilitation and return to play when the patient is asymptomatic may be appropriate care.

First Rib Fracture Resulting in Horner's Syndrome

BACKGROUND

First rib fractures and traumatic Horner's syndrome are both quite rare, which can make it difficult to properly diagnose the combination of these 2 conditions in the emergency department. These conditions may be associated with severe medical emergencies, such as ongoing carotid dissection.

CASE REPORT

We present the case of a 33-year-old man who sustained fractures to his right second, third, and fourth ribs and a delay in the diagnosis of left Horner's syndrome after he was involved in a traffic accident. Left Horner's syndrome was caused by a left transverse fracture of the first rib. This fracture was not detected on chest radiographs and required a 3-dimensional reconstructed neck computed tomography scan for detection. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In the diagnosis of carotid artery dissection, conventional angiography is the criterion standard but is considered invasive. CTA is less invasive, time-saving, and can show more anatomic structures in the neck in addition to the carotid arteries. It is a good screening diagnostic modality in the traumatology department. Although the treatments for Horner's syndrome and first rib fracture are conservative, the early diagnosis of both conditions can resolve the anxiety and uncertainty experienced by both doctors and patients.

First rib fractures in abused infants: a report of three cases

The authors describe 4 first rib fractures in 3 infants, highlighting the difficulty in detecting first rib fractures on skeletal survey. All 4 fractures were the result of physical abuse. A literature search does not find a case of first rib fracture in a healthy infant that is not the result of child abuse. The diagnosis of first rib fracture in an infant should prompt a thorough medical and social evaluation for child abuse.

[Horner's syndrome after fracture of the first rib]

Horner's syndrome after trauma is rare. After visual diagnosis, a search for the cause is urgent due to possible life threatening damage. Intracerebral bleeding and carotid dissection must be excluded. Traumatic Horner's syndrome often seems to be, as in the case described here, caused by a fracture of the first rib. As persistent symptoms are not described, conservative therapy is recommended.

Horner syndrome due to first rib fracture after major thoracic trauma

A case of Horner syndrome diagnosed during the follow-up after major thoracic trauma is presented in this report. A 10-year-old boy was admitted to the emergency service with severe thoracic trauma with left clavicular and first rib fracture after a traffic accident. During the follow-up, myosis and ptosis were recognized in his left eye. Cranial tomography and neurological examination were all normal. The symptoms were thought to be caused by compression of the local hematoma to the cervical ganglia. After 30 days of conservative treatment with tube thoracostomies, he was discharged with his Horner syndrome. After 6 months of follow-up, the findings of Horner syndrome were found to be partially resolved. First rib fracture associated with Horner syndrome is very rarely seen in children, and only 2 cases were found in English-language literature. Our case seems to be the third reported case. Horner syndrome should be kept in mind in cases of first rib fractures. When head trauma is considered, as it can be mistaken with anisocoria, this knowledge may help the surgeon in differential diagnosis.