Fracture-dislocation Of Shoulder Research Articles

Open Elbow Fracture Dislocation with Ipsilateral Shoulder Fracture Dislocation: A Case Report and Literature Review

Open Elbow Fracture Dislocation with Ipsilateral Shoulder Fracture Dislocation: A Case Report and Literature Review

Modified McLaughlin procedure in posterior locked fracture-dislocation of the shoulder

The posterior shoulder dislocation is very uncommon scenario with incidence ranging from 3% - 5% of all different types shoulder dislocations and Locked posterior fracture dislocation of shoulder can be missed due to improper radiological investigations though patient have pain and difficulty in range of movements. The modified McLaughlin procedure in which both the tendon of Subscapularis along with Lesser tuberosity bone chunk were displaced and transferred into the Reverse Hill-Sachs lesion for stabilization.The procedure is aimed to achieve a stable Gleno-humeral joint as well as early and full functional recovery in cases of an acute posterior locked fracture-dislocation of the shoulder. Here, we discuss a posterior locked fracture dislocation which has been missed initially at a peripheral institute even though patient have pain and restricted range of movements. The patient was investigated thoroughly. The surgical note and physiotherapy protocol have been discussed in detail in the case report where the patient returned to pre-injury status in 3 months post-surgery.

Bilateral Locked Posterior Fracture-Dislocation of the Shoulder After Epileptic Seizures Secondary to Cavernous Hemangioma: A Case Report and Literature Review.

BACKGROUND Posterior shoulder dislocation is an uncommon injury, accounting for less than 5% of all glenohumeral dislocations. Bilateral locked posterior shoulder fracture-dislocation is an extremely rare entity with an incidence of 0.6 cases/100 000 people/year. A few reports have been published in the literature, predominantly associated with epileptic seizures. CASE REPORT We present a rare case of a 55-year-old male patient with a history of epileptic seizures, who presented with bilateral, locked, posterior fracture-dislocation of the shoulder following an epileptic seizure. The patient was diagnosed with a cavernous hemangioma, which caused his epileptic episode. He was treated operatively, with a modified McLaughlin procedure performed on both sides, at 1 stage, by 2 surgical teams. The cavernous hemangioma was also resected 2 months later. After a follow-up period of 18 months, no recurrent episodes of instability or dislocation were identified. Full range of motion was present on both sides, with good clinical and radiological outcomes. We also conducted a literature review to elucidate the causes of this rare incidence, along with diagnostic workup and treatment options. We were able to identify 36 cases, involving 72 shoulders of bilateral posterior fracture-dislocations in 30 case reports and 2 case series. CONCLUSIONS Bilateral posterior fracture-dislocation of the shoulder is uncommon. Treatment strategy depends on the chronicity, involvement of the humeral head, and the patient's age and functional level. The target is to restore shoulder anatomy and maintain a functional range of motion.

Good functional results with open reduction and internal fixation for locked posterior shoulder fracture-dislocation: a case series.

There is no standardized therapeutic strategy for locked posterior shoulder fracture-dislocation (PSFD), and no consensus exists on the analysis of preoperative factors. This retrospective study aimed to evaluate functional results and complications in a series of PSFD cases managed with open surgical treatment. Patients diagnosed with locked PSFD who underwent open surgical treatment with reduction and osteosynthesis between April 2016 and March 2020 were included. All participants were treated with open reduction and internal fixation. Functional assessment used the modified University of California, Los Angeles (UCLA) mod scale, American Shoulder and Elbow Surgeons (ASES) questionnaire, subjective shoulder value (SSV), and visual analog scale (VAS). Complications were evaluated clinically and radiologically by X-ray and computed tomography. Twelve shoulders were included (11 patients; mean age, 40.6 years; range, 19- 62 years). The mean follow-up duration was 23.3 months (range, 12-63 months). The UCLA mod, ASES, SSV, and VAS scores were 29.1±3.7, 81.6±13.5, 78±14.8, and 1.2±1.4 points, respectively. The overall complication rate was 16.6%, with one case of post-traumatic stiffness, 1 case of chronic pain, and no cases of avascular necrosis. Open surgical treatment of locked PSFD can achieve good functional results. A correct understanding of these injuries and good preoperative planning helped us to achieve a low rate of complications.

Man With Right Shoulder Pain

A 61-year-old man fell from his scooter resulting in right shoulder pain. The patient required first aid in a local hospital where plain film radiography showed no apparent abnormalities. He then presented to our emergency department due to persistent pain and an inability to move his right shoulder, with his right arm in a supportive sling. Radiography revealed rounding of the humeral head (Figure 1), which was confirmed by point-of-care ultrasound (Figure 2A ).Figure 2Point-of-care ultrasound, using a curvilinear probe in the transverse orientation behind the scapular spine. A, Before the procedure, the humeral head was protruding from the glenoid toward the posterior aspect of the shoulder, indicating a posterior dislocation. B, After the procedure, the humeral head was immediately adjacent to the glenoid, confirming a successful reduction. Ant, anterior side; Post, posterior side; Med, medial side; Lat, lateral side; D, deltoid muscle; G, glenoid; H, humeral head; I, infraspinatus muscle; S, scapula spine.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Posterior dislocation of the right shoulder. Point-of-care ultrasound showed that the humeral head protruded from the glenoid toward the posterior side. A closed reduction of the right shoulder was performed, and point-of-care ultrasound confirmed a successful reduction (Figure 2B). The patient was discharged and was followed up in an outpatient clinic. Posterior shoulder dislocations are rare. Missed diagnoses are frequent because the humeral head appears aligned within the glenoid fossa on plain film radiograph.1Hatzis N. Kaar T.K. Wirth M.A. et al.The often overlooked posterior dislocation of the shoulder.Tex Med. 2001; 97: 62-67PubMed Google Scholar,2Magnussen A.P. Watura C. Torr N. et al.Missed posterior shoulder fracture dislocations: a new protocol from a London major trauma centre.BMJ Open Quality. 2020; 9e000550Crossref Scopus (1) Google Scholar Additionally, patients with shoulder trauma usually have the shoulder immobilized with a sling at the time of imaging, causing the anteroposterior radiographs obtained to be imprecise with the expected rounding of the humeral head. This makes the characteristic “light bulb” sign on a radiograph unreliable.2Magnussen A.P. Watura C. Torr N. et al.Missed posterior shoulder fracture dislocations: a new protocol from a London major trauma centre.BMJ Open Quality. 2020; 9e000550Crossref Scopus (1) Google Scholar Ultrasonography is highly sensitive and specific for the identification of shoulder dislocation.3Gottlieb M. Holladay D. Peksa G.D. Point-of-care ultrasound for the diagnosis of shoulder dislocation: A systematic review and meta-analysis.Am J Emerg Med. 2019; 37: 757-761Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar Normally, the humeral head appears as a hyperechoic, semicircular line with an acoustic shadow immediately lateral to the glenoid. The humeral head will not be congruent to the glenoid in shoulder dislocations, appearing deeper with an anterior dislocation and more superficial with a posterior dislocation.

Proximal humeral fracture-dislocations: which patterns can be reduced in the emergency department?

Shoulder fracture-dislocations can represent a challenging management scenario in the emergency department (ED) because of concern for the presence of occult fractures that may displace during a reduction attempt. The alternative, a closed reduction attempt in the operating room, has the benefit of full paralysis but requires additional resource utilization. There is limited guidance in the literature about the risks of an initial reduction attempt in the ED as a function of fracture pattern to help guide physicians with this decision. This was a retrospective case review of adult patients with shoulder dislocations and fracture-dislocations seen in the ED at a level 1 trauma center over a 10-year period. Imaging and medical records were reviewed to evaluate whether the reduction attempt was successful, unsuccessful without worsening, or unsuccessful with worsening alignment of any fractures, as well as the ultimate clinical outcome. We identified 165 patients with fracture-dislocations and 484 patients with simple dislocations during the same period. Of the patients with fracture-dislocations, 103 had greater tuberosity fractures, 12 had nondisplaced surgical neck fractures, and 50 had displaced surgical neck fractures. None of the patients with simple dislocations had displacement during an ED reduction attempt, including 100 patients aged >65 years. Of the 103 patients with greater tuberosity fracture-dislocations, only 1 had displacement of a humeral shaft fracture during ED reduction. Displacement occurred in 6 of 8 patients with nondisplaced neck fractures who underwent an initial ED reduction attempt vs. 1 of 4 patients who underwent the initial reduction attempt in the operating room. ED reduction was attempted in 25 of the 50 displaced humeral neck fracture-dislocations and was successful in 10 of these (40%). For patients with greater tuberosity fracture-dislocations, there is a low rate of displacement with a reduction attempt in the ED, but an ED reduction attempt in nondisplaced neck fractures is not recommended because of the high rate of displacement. For displaced neck fractures, closed reduction can be successful in select patients. Finally, these data confirm prior reports that closed reduction of simple shoulder dislocations in patients aged >65 years is safe in the ED.

Traumatic pediatric shoulder fracture-dislocation in a 14-year-old child

Proximal humerus fractures is often encountered in pediatric traumatology, while scapulohumeral dislocation is rare, and its association with the fracture of the proximal humerus is exceptional. This makes its management subject to discussion. We report the case of a fracture of the upper end of the humerus associated with scapulohumeral dislocation in a 14-year-old child, the victim of shoulder trauma with direct shock, treated by open-air reduction.

Functional results of shoulders Neer’s prosthesis for four part fracture dislocation of shoulder

<p class="abstract"><strong>Background:</strong> Objective was to study the clinical and functional outcome of shoulder hemi-arthroplasty using Neer’s prosthesis in four part fracture dislocation of shoulder.</p><p class="abstract"><strong>Methods:</strong> The study was conducted on patients who underwent shoulder hemi-arthroplasty using Neer’s prosthesis for four part fracture dislocation of shoulder in Department of Orthopaedics, GMCH Aurangabad from January 2020 to January 2021. The patients were assessed clinically and functionally using Shoulder range of motion, Visual Analog Scale (VAS), American Society of shoulder and elbow (ASES) score and Constant-Murley score and radiological assessment at 3, 6 and 12 months.<strong></strong></p><p class="abstract"><strong>Results:</strong> At one year follow up of 30 patients, no loosening or dislocation of prosthesis was detected, and mean forward elevation of 129.33<sup>o</sup> (90<sup>o</sup> - 150<sup>o</sup>), mean external rotation of 26.7<sup>o</sup> (18<sup>o</sup> – 34<sup>o</sup>), mean internal rotation of 47.86<sup>o</sup> (33<sup>o</sup>-58<sup>o</sup>), the mean ASES score of 79.46 (range 68-88), the mean VAS score of 1.5 (range 1-3) and mean Constant-Murley score of 82.9 (range 72-94) were achieved. 1 patient developed axillary nerve injury which recovered 6 weeks after surgery and 1 diabetic patient developed superficial infection which healed with antibiotics.</p><p class="abstract"><strong>Conclusions:</strong> Hemiarthroplasty with Neer’s prosthesis can be utilized in four part fracture dislocations of humerus with poor bone stock risking avascular necrosis of head and screw cut out with satisfactory outcome.</p>

Recurrence rates and factors affecting recurrence after traumatic anterior shoulder dislocation

Objective: To investigate the factors affecting the recurrence of anterior shoulder dislocation, identify the patient group with the highest recurrence rate for shoulder dislocation, and determine the patient population to be recommended surgical treatment after primary dislocation.
 Material and Methods: Patients diagnosed with primary shoulder dislocation and treated in our hospital between January 2005 and January 2017 were retrospectively screened. Of the 1395 patients identified, 1253 were reached by phone to obtain follow-up information. Patients whose follow-up information was not available, those with posterior dislocations, multidirectional instabilities, general joint hypermobility, traumatic nerve injury or shoulder fracture-dislocations (including greater tuberosity and glenoid fractures), and those that had undergone surgical treatment after primary dislocation were excluded from the study. The general joint laxity of the patients was evaluated using the Beighton scale. Patients with traumatic primary anterior shoulder dislocation and at least two years of follow-up data were included in the study and divided into three age groups as under 20, 20 to 40, over 40. 
 Results: After applying the exclusion and inclusion criteria, 1,004 patients were included in the study. Recurrence was detected in 408 of these patients (40.6%). The highest recurrence rate was in the under 20 years old group at 52% (88/170). The recurrence rate was determined as 43% (283/659) for the 20-40 years group and 21% (37/175) for the over 40 group. It was determined that except for age, gender and presence of bone defects (Hill-Sachs lesion), the remaining parameters, namely immobilization time, injury mechanism, presence and type of sports activity, dominant-side dislocation, and smoking had no significant effect on the risk of recurrence after primary dislocation.
 Conclusion: In conclusion, the surgical treatment option should be presented to young male patients with bone defects after primary dislocation and they should be informed about the possible problems due to recurrent instability.

A case that gives you a cold shoulder – bilateral posterior fracture dislocation of shoulder after electrical shock: A rare case report

Introduction: Posterior dislocation of both shoulders is relatively rare and epileptic seizures has been considered as a common cause. Electrical injury is a rare cause of posterior shoulder dislocation. These cases are of special interest because most of them are missed on initial examination. Here we present a unique case of bilateral posterior dislocation of the shoulder with heterogeneous injury pattern- with one shoulder exhibiting reverse Hillsach’s lesion and the other isolated lesser tuberosity fracture. We will discuss mechanism of injury, investigative parameters and treatment protocols followed.Presentation of case: This report presents a case of bilateral posterior shoulder fracture dislocation after electrical shock. We were able to find a few individual case reports describing this condition. The case was acute and had a heterogeneous injury pattern of Reverse hill sach and Isolated lesser tuberosity fracture. Our treatment in this case consisted of closed reduction under general anesthesia of one shoulder and surgical reduction of other shoulder by McLaughlin procedure. Post operatively orthoses was used to keep the shoulders in abduction and external rotation. A rehabilitation program was begun after 3 weeks of immobilization. After 6 months of injury the patient has returned to work. 24 months postoperatively, at final follow-up, he was painless and capable of performing all of his daily activities.Discussion: The amount of bilateral shoulder dislocations after electrical injury with the following injury pattern is not reported but is known to be very rare. The aim of this case presentation is to report an example for this rare entity, highlight the difficulties in diagnosis and review the treatment options.Conclusion: Physical examination and radiographic evaluation are important for quick and accurate diagnosis. Early detection and treatment of such a condition is extremely important.

Should closed reduction be attempted in the emergency department for an acute anterior shoulder fracture dislocation?

BackgroundWhether an anterior shoulder fracture dislocation should be reduced under sedation in the emergency department is still a dilemma. This retrospective study aimed to determine when it is safe to perform a closed reduction based on the fracture pattern.MethodsSurgically treated anterior shoulder fracture dislocations over eight years were classified into three groups. Group 1 involved an isolated greater tuberosity fracture. Group 2 and 3 involved surgical and or anatomical neck fractures. In group 2, the head and the shaft fragments were displaced together anteriorly and inferiorly; whereas in group 3, the head was displaced and locked under the glenoid, but the shaft migrated superiorly. The outcome and complications of closed reduction were reviewed.ResultsTwenty-nine patients with 30 surgically treated anterior shoulder fracture dislocations were reviewed. These included twelve patients (thirteen shoulders) in group 1, six patients in group 2, and eleven patients in group 3. Closed reduction was attempted in twelve shoulders in group 1, five shoulders in group 2, and six shoulders in group 3. Eleven group 1, four group 2, and none group 3 dislocations were successfully reduced. The patient who failed reduction in group 1 sustained an iatrogenic anatomical neck fracture. One patient failed reduction in group 2. His surgical neck fracture was displaced further after manipulation. No other complications occurred after closed manipulation.Discussion and ConclusionClosed reduction under sedation is usually successful and safe for group 1 injuries with an iatrogenic complication rate of only 8.3% (1/12) in our series. It should also be considered for group 2 injuries as 80% (4/5) were successfully reduced. However, further displacement from the reduction maneuver may warrant an urgent open reduction. Closed reduction is futile for group 3 injuries. We recommend an acute management algorithm based on our results.

Ipsilateral shoulder and elbow dislocation: Camel bite-related injury

Ipsilateral dislocation of the shoulder and elbow joints is a quite rare injury. Due to its rare presentation, one of the two-dislocation diagnoses can be delayed or even missed. We present a unique case of camel-bite injury, resulting in ipsilateral shoulder and elbow fracture dislocation with open ulna shaft fracture that has not been reported in the English literature before. Camel-bites injuries should be taken seriously as it can result in severe, devastating open injuries. The gripped extremity should raise the suspicion of multiple injuries, so careful assessment of the entire extremity should be carried out. Moreover, proper surgical and medical management can prevent unpleasant outcomes.

Posterior shoulder fracture-dislocation: A systematic review of the literature and current aspects of management

PurposePosterior fracture-dislocation of shoulder is an infrequent traumatic event; however, most orthopaedic surgeons may face the challenge of treating it. The aim of this study is to review and summarise systematically the current principles of the management of this complex injury, and create a treatment algorithm. MethodsBoth PubMed and Scopus Databases were systematically searched for the terms “posterior shoulder fracture-dislocation” or “posterior glenohumeral fracture-dislocation” or “posterior glenoid fracture-dislocation” for articles written in English and published in the last decade. ResultsA total of 900 articles were identified, of which 13 were retained for analysis. A total of 153 patients (161 shoulders) were identified. These patients were treated either with open reduction and internal fixation, modified McLaughlin procedure, allograft/autograft humeral head reconstruction or shoulder arthroplasty. The mean age was 40.15 years. The mean postoperative Constant score in cases treated by open reduction and internal fixation was 86.45, whereas by bone graft was 84.18. Further, the mean postoperative Constant score was between 79.6 and 67.1 in those that were managed by modified McLaughlin and arthroplasty procedure, respectively. ConclusionThe management of posterior shoulder fracture-dislocation may be challenging, and the best surgical option depends on many variables such as the chronicity of the injury, the presence of a fracture at the level of the surgical neck or tuberosities and the extend of the Hill-Sachs lesion if any. A treatment algorithm is proposed, based on the current literature in an effort to create a consensus for these injuries. For the acute shoulder fracture-dislocations, an open reduction should be performed. For the chronic fracture/dislocations in the elderly low-demand patients, conservative treatment should be performed. For the rest of the patients, depending on the severity of the Hill-Sachs lesion different surgical options are available such as the McLaughlin technique, the use of an allograft, osteotomy or arthroplasty.

Traumatic shoulder fracture-dislocation in a child: An innovative method of closed reduction

Traumatic shoulder dislocation with proximal humerus fracture is a rare entity among children and treatment is always challenging. We present the case of a child with anterior dislocation of the shoulder associated with complete displaced proximal humerus metaphysis fracture. The fracture was treated by closed reduction using an innovative joystick technique and then fixation by two intramedullary K-wires. The dislocation was easily reduced after the fixation of the fracture. This method of treatment enables us to achieve excellent radiological and clinical results in a short time.

Acute Traumatic Posterior Shoulder Dislocation With Greater Tuberosity Fracture

INTRODUCTION:Posterior shoulder dislocation is a rare injury and represents 2-5% of all shoulder dislocation cases. Even less frequent , posterior fracture-dislocation represents 0.9 % of shoulder fracture dislocation. Mechanism of injury include a traumatic event with axial loading of the adducted , internally rotated arm or more commonly from violent muscle contraction following a seizure or electrocution injury. Delays in diagnosis it are common, estimating 50 % are missed and it can lead to chronic pain, stiffness and long-term functional disability.METHOD:A 44 years old male was brought to our emergency department following road traffic accident. He was riding a motorcycle when he was hit by car from the left side. He complained of severe pain and functional disability of his left shoulder. Radiographs revealed posterior shoulder dislocation (light bulb sign) with quiry greater tuberosity (GT) fracture. CT scan was performed to assess fracture displacement. U slab was then applied, and the patient was taken to operation theatre after a routine blood investigations.RESULT:The patient was placed in semi beach position under general anesthesia. Incision was made via transdeltoid approach. Intraoperatively, posterior dislocation of the humeral head was confirmed. GT fragment size 2.7 cm x 1.6 cmwas indentified and reduced with temporary Kirschner-wires. The reduction was confirmed under image guidance and final fixation achieved with two partially threaded 4.0 mm cannulated screws. The shoulder was then immobilized with a sling 2 weeks subsequently pendulum exercise and progressive range of motion exercise was started.DISCUSSION:Inadequate radiograph including axillary view and poor physical examination are the main factors of misdiagnosis.The physicalfindings that may present are shoulder locked in an internally rotated posititon with limited external rotation , prominent posterior shoulder and coracoid . Radiograph will showing positive rim sign , absence of the half-moon overlap , light-bulb sign, and the trough line. A delay in diagnosis and treatment of posterior shoulder dislocation or fracture-dislocation has increased risks of nonunion, subsequent humeral head collapse, avascular necrosis and post-traumatic arthritis.CONCLUSION:Posterior dislocation of shoulder associated with greater tuberosity fracture is a rare and frequently missed injury. A thorough clinical and radiographic evaluation should avoid the missed diagnosis.REFERENCES:Figueiredo A et al Posterior fracturedislocation of the shoulder: An often unrecognized traumatic injury Orthopedics, Traumatology and Sports Med Int Journal (2018) 1 :8-11

Diagnostic accuracy of Fresno-Quebec Rules and risk factors for an associated fracture in patients presenting to the emergency department with anterior shoulder dislocation: A retrospective study.

Anterior shoulder dislocation is the most common shoulder injury in patients presenting to the emergency department (ED). Up to 25% of these injuries are fracture-dislocations. In general, the standard approach is to obtain plain radiographs before and after reduction. Fresno-Quebec Rules (FQR) are described to identify the patients who require an x-ray before reduction to reduce radiation exposure and delays in treatment. We aimed to evaluate the efficacy of clinical predictors used in the Fresno-Quebec algorithm for detecting a shoulder fracture-dislocation. Records of patients who presented to the Emergency Department with presumed shoulder dislocation were retrieved and retrospectively analyzed according to 'Fresno-Quebec Rule (FQR)'. Sensitivity, specificity, and predictive values of FQR for detecting associated injuries were calculated. Eighty-nine (65.9%) men and 46 (34.1%) women were included. The mean age of patients was 46 years (16-89). Ninety-nine (73.3%) of the cases had their shoulder dislocated for the first time, whereas 36 (26.7%) patients had a recurrent dislocation. Fifty percent of the patients (18 cases) with recurrent dislocation presented with an atraumatic episode. The remaining 18 patients with a history of recurrent dislocations had their shoulder dislocated as a result of trauma, and four (22%) of them had fracture-dislocation. Using the Fresno-Quebec rules yielded 100% specificity for the diagnosis of fracture-dislocation. The severity of the injury mechanism was not predictive in traumatic but recurrent dislocations. Only one of four patients with a fracture-dislocation in the traumatic recurrent dislocation group had high energy trauma. FQR has 100% sensitivity in detecting fracture-dislocations in patients admitted to ED with anterior shoulder dislocation. It utilizes simple parameters that are easy to use and recall. Using these rules, 30% of unnecessary radiographs can be avoided, saving time and money and reducing radiation exposure in anterior dislocations.

Posterior Shoulder Fracture Dislocations Associated With Seizure Disorders

Background: Posterior fracture dislocation of the shoulder is an extremely rare injury and is associated with poor outcomes if not managed properly and in a timely manner. When associated with seizure disorders the injuries are likely to be more serious a compared to simple posttraumatic cases. Only about 4% of glenohumeral dislocations are posterior and 1% have an associated fracture of the humeral head. Methods: This case report is about posterior shoulder fracture dislocations associated with first seizure disorders in previously normal young adult patients aged 21 and 38 years who were not on treatment for seizure disorders. Both patients were treated by open reduction and internal fixation using proximal humerus locking plates after failed attempted closed reduction. Results: Both patients had a good outcome with fracture healing and good range of motion at one year of follow up. Conclusion: Computed Tomography Scanning (CT Scan) is useful in pre operative assessment of the injury pattern since upto 50% of the posterior dislocations are missed on plain AP X-ray of the shoulder. Open reduction via the deltopectoral approach offers the best chance of anatomic reduction with better outcomes in young patients with a posterior fracture dislocation especially the locked ones.

Anterior Shoulder Fracture Dislocations in A Patient With Stiffmans Syndrome and Convulsive Disorder: Rare Case Report

Anterior shoulder fracture dislocation is a challenging case though commonly seen in conjunction with convulsive disorders. No case of stiff-Person Syndrome (SPS) presenting with anterior fracture dislocation is reported in the literature. SPS is estimated to have a prevalence of about one per million with the first known description being attributed to Moersch and Woltman in 1956. The diagnosis and injury patterns of anterior fracture dislocation are more clearly seen on Computed Tomography (CT) Scans which also aids in planning for the surgical management. The treatment outcome after surgical reduction and internal fixation of the fracture with dislocation is associated with excellent functional results.

Delayed presentation of four part fracturedislocation of shoulder - reduction techniques

Delayed presentation of four part fracturedislocation of shoulder - reduction techniques

A case report: Simultaneous bilateral posterior shoulder and unilateral central acetabular fracture dislocations secondary to epileptic seizure

Fracture dislocations of extremities are a possible complication following epileptic seizures. Management mainly depends on the severity of the injury and the current medical status of the patient. We describe a rare case of bilateral posterior shoulder and unilateral central acetabular fracture dislocations without direct trauma after a convulsive seizure related to lung cancer with brain metastases. Two weeks after the seizure, we performed an open reduction and internal fixation (ORIF) with locking plate to treat bilateral posterior shoulder fracture dislocations when the patient’s neurological condition became more stable. However, nonoperative treatment was selected for the acetabular fracture dislocation because of the patient’s advanced-stage cancer. Since the patient was responding well to the newest target therapy for his lung cancer, and his life span is beyond our estimate, we, therefore, performed a total hip replacement 6 months later because of traumatic osteoarthritis development. The clinical outcome was satisfactory at the 6-month follow-up. Due to medical progress in non-small cell lung cancer treatment, we consider aggressive treatment may be necessary even in such advanced stage patients.