Isolated fracture of the first rib is uncommon, but has been reported to occur in sports such as basketball, baseball, and dancing. It has not been reported to occur in gymnasts. Usually, these fractures heal with an adequate period of rest. Rarely do first rib fractures become nonunions. They have been felt to be asymptomatic and are usually found incidentally on routine chest roentgenograms. Symptomatic nonunion of a first rib fracture has not been reported previously. Our patient did not respond to nonoperative treatment and required surgical intervention to alleviate her symptoms. We agree that most fractures of this type heal without complications. However, if a persistently symptomatic nonunion ensues, we suggest transaxillary resection of 90% or more of the first rib.
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