ABSTRACT
Case Report 26: Missed odontoid fracture. JG was a 15-year-old boy who hurt his neck when he fell from a horse. He attended the Accident and Emergency department within 3 hours, complaining of a painful stiff neck. He was holding his head in his hands. The young casualty officer thought that routine X-ray films were normal, and JG was sent home wearing a collar. He was told to see his GP. He discarded the collar after a few days, and the neck stiffness gradually settled, but thereafter, whenever he headed a football his neck was painful. Because of mild continuing neck pain, he had a further X-ray a year after the injury, which now showed a displaced type-2 fracture of the odontoid (a fracture through the narrow portion where the bone is mostly cortical). He was referred to an orthopaedic surgeon who attempted to fuse the odontoid, but it failed to unite. He successfully sued the hospital where the fracture was missed on the first day, because the junior doctor had failed to notice the odontoid fracture which, in retrospect, could be seen as a distinct shadow.
