Nonunion of a first rib fracture causing thoracic outlet syndrome in a basketball player: A case report

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Fractures of the first rib occur infrequently in athletes. This report describes a basketball player with thoracic outlet syndrome (TOS) resulting from nonunion of a first rib fracture with a hypertropic callus. Conservative therapy had been ineffective for 1 year after the patient sustained the injury, and he had complained of numbness in the left upper extremity when his shoulder was in abduction and external rotation. We performed resection of the first rib through a transaxillary approach to achieve neurovascular decompression. This resulted in immediate resolution of the symptoms. There was no recurrence of the numbness in the left upper extremity at 2 years after surgery. Previous reports of sports-associated first rib fracture have indicated that it has a relatively good prognosis. However, nonunion of a first rib fracture may lead to TOS that is unresponsive to conservative treatment. Therefore, this type of fracture should be followed-up carefully.

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