title: Missed lumbar transverse process fractures in a high school football player.
abstract: OBJECTIVE
  To discuss the case of a football player who had suffered a transverse process fracture of the lumbar spine that was overlooked on initial chiropractic and medical examination.
  
  
  METHODS
  A 17-year-old male football player had been speared in the back by another player. He reported severe initial pain that caused him to fall to the ground, and there was a moderate degree of pain at the time of his chiropractic examination 1 week after injury.
  
  
  RESULTS
  Initial chiropractic treatment consisted of spinal manipulation to the lumbar spine. Follow-up care consisted of lumbar spine radiographs that showed evidence of a lumbar transverse process fracture at 2 levels. The boy was referred to his medical doctor, who was not convinced of the presence of a fracture and returned him to play. A computed tomography scan was subsequently performed; this confirmed fractures of the transverse processes of L2 and L3. The patient was precluded from contact sports for 4 weeks. Chiropractic care 3 weeks after injury included physiotherapy and drop table mobilization to the sacroiliac joints. The patient returned to play 4 weeks after the injury.
  
  
  CONCLUSIONS
  Transverse process fractures commonly occur secondary to blunt trauma in contact sports such as football. With high-force direct trauma, radiographs should be performed to rule out fracture before returning the athlete to play or commencing spinal manipulation.
authors.affiliation: Clinical Associate Professor, Los Angeles College of Chiropractic, Whittier, Calif 90609, USA.
authors.forename: R
authors.initials: R
authors.lastname: Brynin
authors.forename: L
authors.initials: L
authors.lastname: Gardiner
mesh_terms: D000293:Adolescent; D003951:Diagnostic Errors; D005538:Football / Q000293:injuries*; D050723:Fractures, Bone / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D008297:Male; D020393:Manipulation, Spinal; D011859:Radiography