Unstable occult cervical-spine fracture.

Recognition of injuries to the cervical spine is of critical importance. Such injuries may be difficult to recognize in patients who have an altered level of consciousness or other significant injuries. We present the case of an alert ambulatory patient with no complaint of neck pain, no tenderness of the neck on physical examination, and no history of trauma who, while being evaluated for fever, was found to have an unstable cervical-spine fracture that was not present on radiographs done one year earlier.