Abstract
Background:
First rib fractures are an infrequently encountered injury, especially in the young athlete. Incidence and natural history of those with first rib fractures sustained during sport is poorly elucidated in the literature, contributing to variability of treatment of this injury. Thus, the purpose of this study was to characterize first rib fractures and their treatment outcomes, specifically among a case-series of young athletes.
Hypothesis:
Adolescent athletes with first rib fractures will have favorable outcomes that can be achieved with a variety of conservative treatment measures.
Methods:
A retrospective review of patient charts identified via electronic health record diagnosis code query resulted in 248 patient charts from one tertiary children’s hospital, and 5 additional patients were added from a second tertiary children’s hospital, as identified by review of clinic visits. Inclusion criteria were designated as patients under age 18 and with injuries sustained during athletic participation. Patient characteristics and information related to injury and recovery courses were collected.
Results:
A total of 13 children met inclusion criteria. Mean age at presentation was 15.4 ± 1.2 years old. Of those, 69.2% (9/13) were female. Nine were traumatic in nature, and 4 were stress fractures. Injuries occurred across both contact sports (football, lacrosse, wrestling) and non-contact sports (softball, baseball, volleyball). Over half (7/13, 53.8%) were prescribed physical therapy (PT), but only 4 out of those actually attended physical therapy, with an average of 2.6 ± 4.1 PT sessions attended. While 5 patients (38.5%) presented with an initial strength deficit related to their injury, all 5 patients regained full strength by final follow-up visit. All 13 patients experienced full symptom free return to activities at a mean duration of 3 months (range 1 day to 15 months).
Conclusion:
First rib fractures in adolescent athletes may vary in clinical presentation, though outcomes appear to be largely favorable. While physical therapy can be an important component of rehabilitation for select patients, a successful recovery may still be achieved with conservative measures that do not include physical therapy. Additional research may be warranted to further delineate factors contributing to incidence of and recovery from first rib fractures in the young athlete, but prescribed time off from sport via activity modification appears to be safe and effective in management.