Abstract
Background. Fracture resulting from household electric shock is uncommon. When it occurs, it is usually the result of a fall; however, electricity itself can cause sufficient tetany to produce a fracture. We present the case of bilateral fractures of the distal radii of a 12-year-old boy which were sustained after accidental shock. The literature regarding fractures after domestic electric shock is also reviewed. Methods. An Ovid-Medline search was conducted. The resultant articles and their bibliographies were surveyed for cases describing fractures resulting from a typical household-level voltage (110–220 V, 50–60 Hertz) and not a fall after the shock. Twenty-one articles describing 22 patients were identified. Results. Twenty-two cases were identified. Thirteen were unilateral injuries; 9 were bilateral. Proximal humerus fractures were most frequent (8 cases), followed by scapula fractures (7 cases), forearm fractures (4 cases), femoral neck fractures (2 cases), and vertebral body fracture (1 case). Eight of the 22 cases were diagnosed days to weeks after the injury. Conclusions. Fracture after electric shock is uncommon. It should be suspected in patients with persistent pain, particularly in the shoulder or forearm area. Distal radius fractures that occur during electrocution are likely due to tetany.
Highlights
Electricity can damage human tissue in the 4 following ways [1–9]:(1) disruption of physiologic conduction systems, including cardiac contraction and diaphragm excursion, leading to arrhythmia and apnea;(2) thermal energy generated by the electrical current;(3) electroporation of cell membranes occurs leading to a disruption of intracellular ion and protein balance, and apoptosis;(4) mechanical injury due to a fall or forceful muscle contraction.The degree of electrical injury is dependent on the currant, voltage, duration of contact, tissue resistance, and the path of the current flow through the body [1, 3, 4].Initial medical care after electrical injury focuses on the most common sequellae of electrocution: infection of the burn wounds, myonecrosis leading to acute renal failure, cardiac arrest or arrhythmia, pneumonia, nausea, and vomiting [2, 5]
We present the case of bilateral, apex-dorsal, buckle fractures of the distal radii of a 12-year-old boy which were sustained after accidental shock by a faultily-wired apartment entrance door
Extrapolating from the shoulder fracturedislocation injury pattern, we suggest that tetanic contraction of flexor carpi radialis and flexor carpi ulnaris directly may produce a moment of sufficient magnitude at the distal radius to produce the observed apex-dorsal fracture pattern, similar to shearing forces experienced during fracture-dislocations
Summary
Fracture resulting from household electric shock is uncommon. When it occurs, it is usually the result of a fall; electricity itself can cause sufficient tetany to produce a fracture. We present the case of bilateral fractures of the distal radii of a 12-year-old boy which were sustained after accidental shock. The literature regarding fractures after domestic electric shock is reviewed. The resultant articles and their bibliographies were surveyed for cases describing fractures resulting from a typical household-level voltage (110–220 V, 50–60 Hertz) and not a fall after the shock. Twentyone articles describing 22 patients were identified. It should be suspected in patients with persistent pain, in the shoulder or forearm area. Distal radius fractures that occur during electrocution are likely due to tetany
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