The first rib is a deep structure at the base of the neck. It is not uncommon for ribs to be broken after minor injuries, including sports injuries. However, rib I, which lies at the base of the neck, is surrounded by muscles and soft tissues that provide it with considerable protection. Therefore a patient with a fracture of the first rib has undoubtedly been subjected to a considerable force, which usually occurs in a deceleration injury. Other injuries should always be sought and the patient should be managed with a high level of concern for deep neck and mediastinal injuries.