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.