The first rib has unique anatomy compared to the other ribs in the thoracic cage. It possesses tubercles for muscle attachments ( the anterior and medial scalenes and the serratus anterior) and has caudal grooves for the subclavain vein more proximally and the subclavian artery more distally.
Anatomically, the first rib is protected from blunt trauma by the clavicle and fractures are rare. If the bone is broken, there must be a high index of suspicion for aortic and subclavian vessel injury and injury to the brachial plexus.
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