Bilateral posterior shoulder fracture – dislocation due to seizure, an uncommon injury: A case report

S. Kavin, S. Chockalingam

DNB, Dept of Orthopedics, Kauvery Hospitals, Trichy

Senior Consultant, Dept of Orthopedics, Kauvery Hospitals, Trichy

Background

Shoulder fracture dislocations are commonly noted in the anterior direction. Posterior fracture dislocation can be missed due to its rarity, and difficulty in diagnosing with simple anteroposterior radiograph. A proper lateral view is often difficult in the emergency setting. Seizures are a cause of this condition apart from RTA and Electric shock. Bilateral posterior fracture dislocation of shoulder due to seizure is rare (9 cases only are discussed in literature). We present this case, and emphasize the importance in recognizing the injury without delay, to improve the functional outcome especially to reduce avascular necrosis of humeral head.

Case Presentation

A 63-year’s old male attended emergency department with a complaints of pain and deformity over both shoulders. Following a fall due to a seizure.

On Examination

Showed tenderness of both shoulder joints, decreased range of movements. Both upper limbs were in the position of adduction and internal rotation.

Scan reports

Patient was evaluated by X- ray – fracture dislocation was not obvious on the left side, hence CT scan was performed.

CT scan – bilateral posterior shoulder dislocation with multiple fracture fragments. Patient underwent bilateral ORIF humerus (PHILOS) plating.

Physio rehab was commenced. Progressive clinical and radiological improvements were observed at periodic intervals.

Scan report

Discussion

Traumatic posterior shoulder dislocation was first described in 1838 by Sir Astley Cooper, as a challenging and unusual clinical problem. This injury accounts for 2–5% of all traumatic shoulder dislocations [5] .

Anterior shoulder dislocations are 15.5–21.7 times more common than posterior ones. Moreover, posterior fracture-dislocation is even less frequent, and according to Neer and Foster it represents 0.9% of 1500 shoulder fracture dislocations, with the annual prevalence being 0.6/100000.[6] .

The biophysical basis of posterior dislocation is believed to be a violent involuntary contraction of muscles around the shoulder, especially the internal rotators and the abductors, which are stronger in comparison to the external rotators and adductors.

These muscles pull and rupture the muscle, tendon, labrum, and capsule of the shoulder joint causing shoulder dislocations posteriorly and falls due to seizures cause fractures in addition to the dislocation.

Conclusion

Patients who have seizure are prone for posterior dislocation of shoulder joint .Fracture dislocation of shoulder due to seizure though reported, “Bilateral presentation” are rare in the published literature, and often present late in our population. Our patient is reported here for the rare presentation of bilateral posterior fracture dislocation treated acutely with rigid internal fixation. Initial results are satisfactory pending long term review.

References

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  • Basal O. Dincer R. • Turk B. Locked posterior dislocation of the shoulder: a systematic review.EFORT Open Rev. 2018; 3: 15-23
  • Ketenci IE, Duymus 2021 Copyright OAT. All rights reservl. (2015) Bilateral posterior shoulder dislocation after electrical shock: A case report. Ann Med Surg (Lond) 4: 417-421
  • Ketenci I.E. Duymus T.M. •Ulusoy A. •Yanik H.S. •Mutlu S. •Durakbasa M.O.Bilateral posterior shoulder dislocation after electrical shock: a case report.Ann Med Surg. 2015; 4: 417-421
  • Kowalsky M.S., Levine W.N. Traumatic posterior glenohumeral dislocation: classification, pathoanatomy, diagnosis, and treatment. Orthop Clin N Am. 2008; 39:519–533.
  • Neer C.S., Foster C.R. Inferior capsular shift for involuntary inferior and multidirectional instability of the shoulder. A preliminary report. J Bone Jt Surg Am. 1980;62:897–908
  • Siu YC, Lui TH Bilateral anterior shoulder dislocation. Arch Trauma Res 3. 2014: e18178.
  • Gosens T. Poels P.J. •Rondhuis J.J. Posterior dislocation fractures of the shoulder in seizure disorders–two case reports and a review of literature. Seizure. 2000; 9: 446-448.

 

Dr. R. S. Kavin
DNB, Dept of Orthopedics

Dr Chokalingam

Dr. S. Chockalingam
Orthopaedic Surgeon

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