Big Ben has apparently experienced a 1st rib dislocation or fracture. First rib dislocations\fractures are rarest of all rib fractures, and are a reflection of severe chest trauma since the first rib is very well protected by the shoulder, lower neck musculature, and collar bone. It requires a much higher impact force to fracture than other ribs. Fractures of the first rib raise immediate suspicion of significant chest trauma. Mortality rates as high as 36% have been reported with fractures or dislocations of the first rib, which are associated with injury vital structures located behind this rib. Such structures include the ascending aorta (one of the most commonly associated with mortality), lung, subclavian artery, and brachial plexus. Other complications associated with first rib fractures include delayed subclavian blood vessel clots and the creation of traumatic aortic aneurysm........all of these complications are of a serious nature. Because of the anatomic relationship of the first rib to the heart (heart located below the level of the first rib), it would be very unlikely that the heart would directly be injured with this type of trauma. However, the ascending aorta which comes off directly from the heart can be torn off its connection to the heart essentially leading to certain death.
For those fortunate enough to reach the hospital alive, I've had to crack my share of chests to save these patients. The first rib is dislocated or fractured most classically in a head-on auto accident with a massiive impact from a high speed steering wheel into the chest. The first rib is located in a recessed position immediately below the collar bone. The heart is not directly behind this rib........the aortic arch is.:
Big Ben is indeed very fortunate to have fared this benignly from such an injury. His physicians better be darn sure that his rib is totally stabilized by the natural long term healing process or with the help of surgical fixation before he is ever allowed back onto the field.