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The patient is a 25-year-old male who presented to urgent care after falling from a height of two sto- ries, landing flat on his feet. He is able to ambulate, though only with pain. In addition, he complains of back pain.

He is generally healthy, and no neurological deficit was found.

View the x-ray taken (Figure 1) and consider what your next steps would be. Resolution of the case is described on the next page.

Clinical Challenge 2: April, 2007

Nahum Kovalski, BSc, MDCM

Clinical Researcher at TEREM Emergency Services