Fracture of the first rib occurred in six patients after cardiac surgery through a midline sternotomy. Two of the fractures could not be seen on the chest films and were demonstrated only on oblique radiographs of the cervical spine. Symptoms simulating myocardial infarction and/or pulmonary embolism were present in three of the six cases. In a review of 50 randomly selected cases of midline sternotomy, first-rib fractures were found in 3(6%).
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Curtis et al. (1975) studied this question.