The first sternocostal joint is a synchondrosis rather than a synovial joint, with the first costal cartilage directly fused to the manubrium without a joint cavity. This makes it immobile and permanently rigid, distinguishing it from ribs 2 through 7 which have small synovial sternocostal joints allowing limited motion.
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The rigidity of the first sternocostal synchondrosis makes it resistant to dislocation, but fractures through the first rib or cartilage indicate significant force and are associated with major vascular and plexus injuries. The first costal cartilage often calcifies or ossifies with age, which can look striking on chest radiographs but is a normal finding.
High-energy first rib fracture indicating significant thoracic force with associated subclavian vessel and brachial plexus injury risk requiring urgent vascular assessment.
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