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Delayed or missed diagnoses in the setting of spinal fracture can lead to catastrophic neurological injury.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case presentation<\/jats:title><jats:p>A man struck by a motor vehicle suffered multiple traumatic injuries including numerous rib fractures, a mechanically unstable pelvic fracture, and also had suspicion for an aortic injury. Unfortunately, the upper thoracic segment (T1-5) was only visualized with axial images based on the electronic data. Several days later, a contrast CT scan obtained to check the status of suspected aortic injury revealed T3-T4 subluxation indicative of an unstable extension-type fracture in the setting of DISH. Due to the missed injury and delay in diagnosis, surgery was not performed until eight days after the injury. At surgery, the patient was found to have left T3-T4 facet joint infection as well as infected hematoma surrounding a left T4 transverse process fracture and a traumatic T4 costo-transverse joint fracture-subluxation. Despite presence of infection, an instrumented posterior spinal fusion from T1-T6 was performed and the patient recovered well after antibiotic treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>A T3-T4 unstable DISH extension-type fracture was initially missed in a polytrauma patient due to inadequate imaging acquisition, which caused a delay in treatment and bacterial seeding of fracture hematoma. Complete imaging is especially needed in obtunded patients that cannot be thoroughly examined.<\/jats:p><\/jats:sec>","DOI":"10.1186\/1754-9493-5-25","type":"journal-article","created":{"date-parts":[[2011,11,9]],"date-time":"2011-11-09T20:21:42Z","timestamp":1320870102000},"update-policy":"http:\/\/dx.doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["A missed injury leading to delayed diagnosis and postoperative infection of an unstable thoracic spine fracture - case report of a potentially preventable complication"],"prefix":"10.1186","volume":"5","author":[{"given":"Hiroyuki","family":"Yoshihara","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Todd F","family":"VanderHeiden","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip F","family":"Stahel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2011,10,14]]},"reference":[{"issue":"2","key":"113_CR1","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1056\/NEJM200007133430203","volume":"343","author":"JR Hoffman","year":"2000","unstructured":"Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI: Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. 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