Bilateral posterior fracture dislocation of the shoulders following seizure.
Bilateral posterior fracture dislocation is a rare injury known to be associated with seizures. Convulsion was found to be the cause of fracture dislocation in 78% of the cases reported. The mechanism of injury was described by Shaw in 1971. The management depends largely on the severity of the injury. In many cases reported, the fracture was a large compression defect in the anteromedial aspect of the articular surface of the humeral head. It has been suggested that for defects that involve less than 20% of the articular surface closed reduction can be attempted. Rush nail or percutaneous K wires can be used to maintain reduction. Open reduction is necessary for defects that are involving 20-40% of the surface. The aim in these cases is to reconstruct the proximal humerus if possible by the use of internal fixation. If reconstruction is not feasible, a modified McLaughlin procedure can be used to prevent chronic instability of the shoulder. This procedure involves re-implanting the subscapularis tendon into the defect. Reconstructing fractures that involve more than 40% of the articular surface or 4-part fracture is not usually successful. These fractures are associated with a high the risk of avascular necrosis. Hemi-arthroplasty or total shoulder replacement is generally regarded as better option as they offer rapid recovery and eliminate the possibility of multiple procedures if fixation fails.
Tellisi
Nazzar K
NK
Department of Orthopedics and Trauma, Good Hope Hospital, Rectory Road, Sutton Coldfield, Birmingham, United Kingdom. Tellisi@totalise.co.uk
Abusitta
Gehad R
GR
Fernandes
Richard J
RJ
D003937:Diagnosis, Differential; D004829:Epilepsy, Generalized / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012783:Shoulder Dislocation / Q000000981:diagnostic imaging / Q000209:etiology*; D012784:Shoulder Fractures / Q000000981:diagnostic imaging / Q000209:etiology*