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Rib Fractures and Whiplash

This recent study is a case report of an elderly woman who after crashing into a hedge at approximately 40-mph had bilateral isolated first rib fracture. Since the first rib is protected by the shoulder girdle and muscles, fractures are usually rare and extreme—such as direct trauma, violent muscular contraction, or by chronic stress.

The patient was wearing a seat belt, yet the authors are reluctant to attribute the fracture to the shoulder restraint. The authors relate that seat belt rib fractures are commonly unilateral and are positioned in the lower ribs in the region of the seatbelt buckle. Instead the authors conclude:

"Her rib fractures appear to have been caused by the whiplash mechanism rather than by direct trauma. Therefore first rib fractures in the elderly may occur in isolation, without multiple rib fractures, or signs of multiple trauma."

Qureshi T, Mander BJ, Wishart GC. Isolated bilateral first rib fractures�an unusual sequel of whiplash injury. Injury 1998;29(5):397-398.

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