It is important to identify whether or not a fracture is real or projectional to avoid unnecessary procedures and stress to a patient. There is also a developmental anomaly that may give the appearance of a fracture of the posterior arch. This entity is absence of a portion of the neural arch of C1 on one side. Many of these findings can be avoided if close attention is made to positioning the patient in the lateral projection. However, at times, this may be difficult to achieve, due to the patient's muscular spasms and true anomalies.
Oblique views can be very helpful to rule out true fractures.
If there is still a question, refer to a radiologist. Often a radiologist can give the final answer without having to perform more expensive studies, such as a CT scan or bone scan. All Rights Reserved, Dynamic Chiropractic, 2001.