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Dominant-Sided First-Rib Stress Fracture in a Collegiate Baseball PitcherA Case Report
Peter C. Chimenti, MD1; John C. Elfar, MD1; Brian D. Giordano, MD1
1 Department of Orthopaedic Surgery, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY 14642. E-mail address for P.C. Chimenti: Peter_Chimenti@urmc.rochester.edu. E-mail address for J.C. Elfar: John_Elfar@urmc.rochester.edu. E-mail address for B.D. Giordano: Brian_Giordano@urmc.rochester.edu
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Investigation performed at the Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, New York

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Case Connector, 2013 Oct 23;3(4):e108 1-4. doi: 10.2106/JBJS.CC.M.00019
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The incidence of asymptomatic fatigue fractures of the first rib in the young, active male population is very low; these fractures were observed in only 0.001% of retrospectively reviewed chest radiographs in one series1. First-rib fractures have been postulated to result from several primary mechanisms: high-energy direct impact such as a motor vehicle collision2, indirect trauma such as a fall on an outstretched arm3, fatigue fractures from repeated muscular contracture4, or sudden, violent muscular forces resulting in stress fractures5. Although the exact incidence of first-rib stress fracture caused by sudden muscular contracture is not known, many repetitive activities, including gymnastics, tennis, basketball, weightlifting, and even coughing or sneezing, have been associated with this mechanism6.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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