J Manipulative Physiol Ther. 1996 Sep; 19(7): 480-3.

Missed sacral fracture before chiropractic adjustment.

Plaugher G, Alcantara J, Doble RW.

Palmer College of Chiropractic West, San Jose, California 95134, USA.

OBJECTIVE: Reports of complications after chiropractic adjustments were administered to the lumbar spine and/or pelvis are rare. This case report provides the events associated with a sacral fracture that was not identified before a side-posture sacroiliac adjustment. CLINICAL FEATURES: The patient suffered from blunt, low back trauma as a result of 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 because of an underexposed radiograph; thus, the patient was given a diagnosis of a sacroiliac sprain subluxation. INTERVENTION AND OUTCOME: A specific contact sacroiliac adjustment that uses the innominate as the short lever arm was administered to the patient in the side-posture position. Two adjustments were administered over 2 days. The patient developed sciatic pain after the second adjustment and subsequently referred herself to a medical orthopedist. Additional plain films were obtained, and a diagnosis of a zone 2 sacral fracture was made. The patient was prescribed bed rest; at 6 wk, 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, because the adjustment is not administered with regard to the biomechanics of the trauma or the actual clinical entity under scrutiny. This case study represents the first report of a complication after a sacroiliac adjustment in a patient who had a zone 2 sacral fracture that was missed in the diagnosis.