Serious bicycle crash injury in chiropractic practice – a case report of delayed diagnosis

BACKGROUND: Bicyclists are vulnerable road users and are at risk of serious spinal injury if involved in traffic crashes. In Denmark approximately 25 bicyclists are killed each year and some 20.000 bicycle related casualties are registered in the National Patient Registry each year. In addition to these figures, a large number of casualties remain unregistered despite injury. Many of the casualties will consult chiropractors in primary practice with or without preceding evaluation in the established emergency care facilities. Therefore, chiropractors are expected to be able to proficiently evaluate these patients clinically and radiologically in order to ensure the best possible patient care. CASE PRESENTATION: This report involves a middle-aged female who consulted several physicians following a collision with a motor vehicle while riding a bike. Despite clinical symptoms and consequent examinations she suffered from inadequate diagnostic evaluation until a radiological examination was performed 18 days following the injurious crash identifying unstable cervical spine fractures. CONCLUSIONS: The presented case is an example of the serious spinal injuries bicyclists may suffer when involved in high-energy traffic crashes despite wearing a bicycle helmet. The case report highlights the need for relevant clinical (including radiological) decision strategies when dealing with trauma patients in chiropractic practice. This involves the direct access to radiological procedures with no unnecessary delay when indicated as in most trauma cases. Furthermore, clearly defined and easy accessible referral schemes from primary care settings to emergency departments must be available to the chiropractic physician. Chiropractors are clinically competent to examine and diagnose, including radiologically evaluate, patients who have been injured in traffic crashes. Hence, chiropractors may contribute to the diagnosis, management and rehabilitation of spinal injured patients following many types of crashes and accident, including bicycle crashes.