KCK back fracture

In her late forties with mild asthma and COPD this very active woman was carrying her dog down a flight of steps when she slipped and fell down about 7 steps striking her lower back.  She had immediate severe pain, pre-syncope and no neurologic deficits.  After resting in the sitting position at the bottom of the steps her husband helps her to her feet with much difficulty. Although in moderate to severe pain she wanted to proceed with attending a relative’s funeral and proceeded to get in the car and attend a church service.  Afterwards, the pain persisted at a severe level and she was taken to the Emergency Room of a local hospital.  After an evaluation by a nurse clinician and review of x-rays of the back she was diagnosed with severe strain and given a narcotic prescription for pain and another for muscle relaxation.  Prior to her completed discharge, I asked to review the x-ray and then noted to the nurse practitioner that the x-ray completely missed the area of her greatest pain and tenderness.  New x-rays were taken and she was diagnosed with a compression fracture of two of her lumbar vertebrae!