Abstract
Objective: To determine the prevalence of bony cervical ribs observed on chest radiographs among the adult population of Nowshera, Pakistan.
Methodology: This cross-sectional descriptive study was conducted at the Department of Orthopedics, Qazi Hussain Ahmad Medical Complex, Nowshera, from January 1, 2019, to December 31, 2023. A total of 2856 adult patients admitted for orthopedic fracture fixation underwent chest radiographs (Postero-Anterior view) for anesthesia fitness. These radiographs were screened for the presence of bony cervical ribs and elongated C7 transverse processes.
Results: The overall prevalence of cervical ribs was 6.96% (199 out of 2856 individuals). Bilateral cervical ribs were the most common (4.97%), followed by left-sided (1.01%) and right-sided (0.98%). The prevalence was significantly higher in females (8.67%) than in males (5.97%), with a p-value of <0.0078. Additionally, 1.36% of the study population had elongated C7 transverse processes.
Conclusion: The prevalence of bony cervical ribs in the adult population of Nowshera is notably high compared to many other reported populations. This anatomical variant is more frequent in females. Awareness of this higher prevalence is important for clinicians evaluating patients for thoracic outlet syndrome.

Key words: Cervical rib, chest radiograph, elongated C7 transverse processes, thoracic outlet syndrome.