A missed Jefferson fracture in chiropractic practice.

OBJECTIVE

To review the case of a missed cervical spine fracture in a patient with neck pain.

CLINICAL FEATURES

A 21-year-old thatcher with neck pain presented to a chiropractic clinic after a fall from a roof 4 m high. The hospital radiographs were read as normal. The chiropractor suspected a Jefferson fracture of the atlas after evaluation of the same radiographs.

INTERVENTION AND OUTCOME

The chiropractor retook the anteroposterior open-mouth radiograph to confirm the suspected fracture. The patient was referred for further imaging and underwent neurosurgical treatment, after which he recovered well.

CONCLUSION

Normal radiologic reports from a hospital cannot be relied on for contraindications to manipulative treatment in all instances, as shown in this case of a missed fracture. Chiropractors should therefore always evaluate radiographs that are brought to them.