Journal of Emergencies, Trauma, and Shock
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LETTER TO EDITOR  
Year : 2013  |  Volume : 6  |  Issue : 3  |  Page : 231-232
A unique case of non- traumatic asymmetric shoulder dislocation with four-part fractures of proximal humeri following seizures


Department of Orthopaedics, Melaka Manipal Medical College, Melaka-75150, Malaysia

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Date of Web Publication20-Jul-2013
 

How to cite this article:
Nema SK, Pai DR, Sinha NK, Gupta KK. A unique case of non- traumatic asymmetric shoulder dislocation with four-part fractures of proximal humeri following seizures. J Emerg Trauma Shock 2013;6:231-2

How to cite this URL:
Nema SK, Pai DR, Sinha NK, Gupta KK. A unique case of non- traumatic asymmetric shoulder dislocation with four-part fractures of proximal humeri following seizures. J Emerg Trauma Shock [serial online] 2013 [cited 2020 Apr 7];6:231-2. Available from: http://www.onlinejets.org/text.asp?2013/6/3/231/115358


Sir,

Asymmetric (simultaneous anterior and posterior) shoulder dislocations are rare. To the best of our knowledge only five cases of asymmetric shoulder dislocations have been reported worldwide. [1],[2],[3],[4],[5] None of these cases were associated with four-part fracture of proximal humeri. Musculoskeletal injuries following seizures are frequently missed. [1] The case presented here is of a post-seizure asymmetric fracture dislocation of shoulder with missed initial diagnosis. A 50 year old man presented to us in the outpatient department with complaints of pain and restriction of movements of both shoulders three weeks subsequent to seizures. The patient was seen at a nearby health care facility where apparently, the shoulder injury was missed. Radiograph of both shoulders showed anterior dislocation with four-part fracture of the proximal humerus on the right side and posterior dislocation with four-part fracture of the proximal humerus on the left side. A computed tomography (CT) scan of both shoulders with three-dimensional reconstruction confirmed this injury [Figure 1], [Figure 2] and [Figure 3].
Figure 1: Three-dimensional CT scan right shoulder

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Figure 2: Three-dimensional CT scan left shoulder

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Figure 3: CT scan transverse section showing asymmetric shoulder dislocation

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Serious musculoskeletal injuries like fractures have been associated with seizures. These include fractures around shoulder, pelvis, spines, neck of femur and dislocation of temporomandibular joint. [6] We feel that this case is worth reporting because of several reasons. Firstly, patient sustained asymmetric fracture dislocation of shoulder after seizures which are rare. Secondly, both shoulder dislocations were associated with four-part fracture of proximal humeri, which has not been reported so far. Thirdly, this patient sustained non-traumatic anterior fracture dislocation of shoulder, which again is very uncommon as anterior fracture dislocations are usually due to trauma.This case further highlight that serious musculoskeletal injuries can result because of seizures and should be looked for.


   Acknowledgment Top


We acknowledge Dr. G.S. Vyas Professor and Head Department of Orthopedics, GR Medical College Gwalior, MP, India for permitting us to present this as a case.

 
   References Top

1.Tsionos I, Karahalios T, Zibis AH, Malizos KN. Combined anterior and posterior shoulder dislocation as a manifestation of a brain tumour. Acta Orthop Belg 2004;70:612-5.  Back to cited text no. 1
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2.Aufderheide TP, Frascone RJ, Cicero JJ. Simultaneous bilateral anterior and posterior shoulder dislocations. Am J Emerg Med 1985;3:331-3.  Back to cited text no. 2
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3.Fung DA, Menkowitz M, Chern K. Asymmetric bilateral shoulder dislocation involving a luxatioerecta dislocation. Am J Orthop 2008;37:E97-8.  Back to cited text no. 3
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4.Reddix RN Jr, Hamilton WP. A patient with both luxatioerecta and an anterior shoulder dislocation. Am J Orthop 2008;37:372-3.  Back to cited text no. 4
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5.Galois L, Traversari R, Girard D, Mainard D, Delagoutte J. Asymmetrical bilateral shoulder dislocation. SICOT Online Rep 2003:E024. Available from: http://www.sicot.org/resources/File/IO_reports/02-2003/4-02-2003.pdf [Last accessed on 1 Feb 2013].  Back to cited text no. 5
    
6.Shaw JL. Bilateral posterior fracture-dislocation of the shoulder and other trauma caused by convulsive seizures. J Bone Joint Surg 1971;53:1437-40.  Back to cited text no. 6
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Correspondence Address:
Sandeep K Nema
Department of Orthopaedics, Melaka Manipal Medical College, Melaka-75150
Malaysia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2700.115358

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    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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