Surgery
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Forty-five consecutive patients with 49 fractures of the first rib caused by blunt trauma underwent arteriography. The fractures were classified as posterior, lateral, or anterior and as nondisplaced, minimally displaced, or significantly displaced. Seven patients (14%) had serious vascular injuries: five had posterior injuries, and one had a lateral fracture, and one had an anterior fracture. ⋯ Arteriography is indicated if there is an absent pulse, a brachial plexus injury, or a displaced first rib fracture. Using these criteria all vascular injuries would be detected. The majority (78%) of the patients with first rib fractures could be managed without arteriography.