Management of a stable atlas fracture in a patient with comorbid schizophrenia and alcohol use disorder

Abstract

To our knowledge, there are no existing case reports documenting how to treat a fracture of the high cervical spine in a nonadherent patient. In this case report, we present an adult male with longstanding diagnoses of schizophrenia and alcohol use disorder who originally presented with neck pain after a fall due to alcohol intoxication. He had already been placed in a cervical neck brace (C-collar) at presentation. Preliminary imaging revealed a fracture of the left lateral mass of C1 extending into the left transverse process of the odontoid, without significant widening of the joint, no involvement of the dens, and no vascular compromise. The C-collar remained in place and the patient was transferred to the intensive care unit (ICU) for monitoring of his fracture and alcohol withdrawal. The patient was admitted to the psychiatric unit nine days later through an involuntary hold to ensure proper initial care for the atlas fracture and address his primary psychotic disorder. The patient was ultimately lost to follow up. Because of the sensitive nature of the fracture, and the nonadherence of the patient due to his comorbid schizophrenia and alcohol use, orthopedic surgeons instituted a unique care plan to best suit this individual patient’s needs. In the management of stable high cervical fractures in patients with questionable adherence, conservative measures are more safe, plausible, and effective than surgical intervention.