1. Radiological Findings

Based on the provided chest X-ray images, a distinct fracture line is visible in the right first rib, without any significant displacement or malalignment. No obvious swelling or abnormal density changes are noted in the adjacent soft tissues. The overall thoracic cage structure remains intact, showing no notable abnormalities in the lungs or mediastinum. There are no evident signs of vascular compression.

2. Potential Diagnoses

1. Isolated First Rib Fracture: This is uncommon in children and usually indicates a higher-energy trauma or repetitive stress. Even though this child experienced mild trauma, the possibility of neurovascular bundle involvement should still be considered.
2. First Rib Fracture with Potential Neurovascular Injury: First rib fractures are often associated with subclavian artery or brachial plexus injuries, which should be evaluated alongside clinical signs such as limb sensory disturbances or circulatory issues. However, no apparent neurovascular symptoms have been recorded in this child.
3. Other Thoracic Cage Fractures (e.g., Clavicle or Other Ribs) or Traumatic Injuries: It is necessary to rule out additional rib or clavicle fractures, as well as soft tissue injuries in the thoracic region. Imaging does not indicate any other obvious fracture lines, but clinical examination should still be considered.

3. Final Diagnosis

Combining the patient’s age (11 years), mechanism of injury (relatively low-energy trauma), the radiographic finding of a single fracture line, and no signs of neurovascular compromise, the most likely diagnosis is:

“Right-Sided Isolated First Rib Fracture”

Currently, there is no evidence of any additional fractures or neurovascular complications.

4. Treatment Plan and Rehabilitation

Treatment Strategy:

• Conservative Treatment: For simple and stable first rib fractures without neurovascular injury, conservative management including rest, analgesia, and symptomatic relief is recommended. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can be used to alleviate pain and inflammation.
• Physical Therapy and Rehabilitation Exercises: Once pain is well-controlled and the injury is stable, simple shoulder girdle exercises can be performed to prevent restricted shoulder joint range of motion.
• Surgical Indication: In cases of significant displacement, neurovascular compromise, nonunion, or deformity of the thoracic cage, surgical intervention may be considered. This particular case does not meet the criteria for surgical treatment.

Rehabilitation Training and Exercise Prescription (FITT-VP Principle):

• Frequency: Initially, perform gentle shoulder girdle exercises once or twice a day, depending on pain control and recovery progress. This can gradually be increased to two or three times daily after a few weeks.
• Intensity: Keep the intensity mild to moderate, avoiding excessive stretching or forceful movements. Activities should be limited to a pain-free range of motion.
• Time: Start with sessions lasting 10–15 minutes. As tolerance improves, gradually extend each session to 20–30 minutes.
• Type: Engage in active shoulder exercises such as forward flexion, abduction, and rotation. These can be combined with stretching and mild strength training (e.g., using resistance bands or bodyweight support within tolerated limits).
• Progression: As pain subsides and the fracture stabilizes, gradually increase the range of motion, eventually transitioning back to normal daily activities and light weight-bearing exercises. If discomfort or severe pain occurs, adjust the plan and consult a healthcare professional.
• Safety and Individualization: Because children’s bones and muscles are still developing, it is essential to proceed gradually, avoiding excessive load or forceful stretching. Regular follow-up imaging is advised to monitor fracture healing and adjust the rehabilitation plan as necessary.

Disclaimer

This report is based solely on the provided medical history and imaging data for reference purposes. It cannot replace an in-person clinical diagnosis or the opinion of a professional physician. If the condition changes or symptoms worsen, it is recommended to promptly seek medical evaluation at a hospital or consult a professional physician.