A case report is presented of a young man injured in a motor vehicle accident who subsequently suffered neck and shoulder pain with no radiation. The pain, aggravated by motion and relieved by neck massage, had persisted for five months. Investigation by plain film radiographs, prior to treatment suggested an odontoid fracture. Tomographic radiographs revealed a type II non-union odontoid fracture. Spinal manipulation was contraindicated and this patient went on to surgical stabilization. A type II odontoid fracture non-union should be ruled out in any patient presenting with a history of a motor vehicle accident with head trauma, before manipulation is considered.
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