title: Cervical spine fracture following a motor vehicle accident.
abstract: We present the case of a 50-year-old man who visited our emergency department 12 h after an alcohol-related motor vehicle accident complaining of shoulder pain and neck stiffness. Cervical spine radiographs were obtained and interpreted as normal, and the patient was discharged. Subsequent review by a radiologist raised the question of a second cervical vertebra (C-2) abnormality, and the patient was recalled. Cervical computed tomography (CT) scan revealed an unstable oblique fracture of C-2 and a congenital nonfusion of the arch of C-1. The patient was placed in halo traction, and subsequent radiographs revealed a fracture of the transverse process of C-7. The patient made an uneventful recovery. The limitations of routine cervical radiographs are well-documented, but no feasible alternative exists as a screening procedure. Thus, a certain level of uncertainty must be accepted. Both physician and patient must recognize the limitations inherent in all medical practice and that follow-up examination and treatment are essential.
authors.affiliation: Department of Anesthesia, Massachusetts General Hospital, Boston.
authors.forename: W F
authors.initials: WF
authors.lastname: Eckhardt
authors.forename: M
authors.initials: M
authors.lastname: Doyle
authors.forename: A
authors.initials: A
authors.lastname: Woodward
authors.forename: I
authors.initials: I
authors.lastname: Freundlich
authors.forename: F X
authors.initials: FX
authors.lastname: Rockett
mesh_terms: D000063:Accidents, Traffic; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D005596:Fractures, Closed / Q000000981:diagnostic imaging* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D014143:Traction