C1 BURST FRACTURE

Objective: The presentation of a patient to a chiropractic office with an undiagnosed C1 burst fracture (Jefferson fracture) secondary to he ad trauma from a motor vehicle accident is introduced. Clinical Featur es: A 67-yr-old real estate manager suffered from neck pain and stiffn ess following release from a major metropolitan medical center. Antero posterior open mouth radiographic examination of the cervical spine re vealed 10-mm displacement of the lateral masses of C1 relative to the superior articulating facets of C2, indicating the presence of a C1 bu rst fracture with possible disruption of the transverse ligament. Inte rvention and Outcome: The patient was transferred by ambulance to a lo cal medical center where a CT scan of the cervical spine and neurosurg ical evaluation were obtained. The patient's cervical spine was immobi lized in a Philadelphia collar for 3 months. Follow-up radiographic ev aluation indicated nonunion of the fracture fragments and the patient was referred for further neurosurgical consultation. Conclusion: The p resumption of proper and competent prior medical treatment, without co nfirmation by radiographic examination and review of records, could ha ve resulted in catastrophic consequences for this patient, had chiropr actic manipulation been performed. A history of trauma should be a cle ar signal to the chiropractic practitioner that they should proceed wi th caution, regardless of the patient's prior history of examination a nd treatment.