Arteriography and the fractured first rib: too much for too little?

The prevailing opinion that inlet (first and second) rib fractures carry a high rate of aortic-brachiocephalic injuries was tested in a retrospective analysis of radiographic, angiographic, and surgical records of 214 patients. Two patient populations were defined, identical in all traumatologic and radiologic aspects, except for the presence of inlet rib fractures in one group. Aortic/brachiocephalic trauma occurred at the same frequency in both populations. Because the contemporaneous occurrence of aortic-brachiocephalic wounding and inlet rib fractures is entirely a matter of coincidence, the presence of an inlet rib fracture alone should not constitute an indication for angiography. Vascular studies must be prompted by the presence of clinical signs or by radiographic findings suggesting a hematoma.