Refining Management of Pediatric First Rib Fractures Without Major Trauma.

Purpose: First rib fractures in children are typically associated with high-impact trauma; atraumatic etiologies remain understudied. The purpose of this study is to evaluate the presentation and management of pediatric first rib fractures in the absence of major trauma.

Methods: This is a retrospective study of pediatric patients diagnosed with first rib fractures between 2000-2023 at a quaternary, free-standing children's hospital. Exclusion criteria were major trauma and baseline bone disease.

Results: We identified 24 patients with first rib fracture in the absence of major trauma (median age 14 years, 15 (63%) male). The most common etiologies were exercise (n=8, 33%), stretching (n=5, 21%), and idiopathic (n=5, 21%). The most common symptom was ipsilateral shoulder pain (n=16, 67%). Chest x-ray (CXR) was the primary diagnosis modality (n=16, 67%). Seven patients (29%) had chest computed tomography (CT), which showed no additional pathology. Most first rib fractures were non-displaced (n=19, 79%), and the rest were minimally displaced (n=5, 21%). Most patients did not have any associated injuries (n=20, 83%), 3 patients (13%) had additional rib fractures, and one patient (4%) had concurrent pneumonia. All patients were managed non-operatively; 12 patients (50%) were seen for follow-up with repeat radiological imaging, primarily CXR. Most patients had appropriate healing on initial follow-up; one patient had delayed healing on initial CXR, requiring follow-up CT.

Conclusion: Pediatric first rib fractures can occur in the absence of major trauma; extensive additional workup is often not necessary. Diagnostic chest computed tomography did not yield clinically significant findings beyond x-ray.