Missed sacral fracture prior to chiropractic adjustment: A case report

Journal of Manipulative Physiological Therapeutics, 1996 !9:000-000 (In Press)

Abstract:

Objective: Reports of complications following chiropractic adjustments administered to the lumbar spine and/or pelvis are rare. This case report discusses the events associated with a sacral fracture that was not identified prior to a side posture sacroiliac adjustment.

Clinical Features: The patient suffered from blunt low back trauma due to a fall. Clinical evaluation indicated fixation dysfunction at the left sacroiliac articulation, with minimal edema/tenderness at the inferior portion of the left sacroiliac joint. Initial radiological evaluation failed to disclose the Zone 2 sacral fracture due to an underexposed radiograph; thus the patient was diagnosed as having a sacroiliac sprain-subluxation.

Intervention and Outcome: A specific contact sacroiliac adjustment using the innominate as the short lever arm was administered to the patient in the side posture position. Two adjustments were administered over a two day period. The patient developed sciatic pain following the second adjustment and subsequently self-referred herself to a medical orthopedist. Additional plain films were obtained, and a Zone 2 sacral fracture was diagnosed. The patient was prescribed bed rest, and at six weeks, her symptoms resolved and she returned to normal activity levels.

Conclusion: Fractures of the spine and pelvis need to be considered in a patient who suffers blunt trauma. An adequate radiographic examination is necessary to make the appropriate diagnosis. Failure to diagnose the fracture may lead to complications, since the adjustment is not administered with regard to the biomechanics of the trauma or the actual clinical entity under scrutiny. The case study represents the first report of a complication following a sacroiliac adjustment in a patient with a missed Zone 2 sacral fracture.