Case of bilateral non-traumatic posterior fracture-dislocation of humeral heads

   Posterior shoulder dislocation is a rare pathology, accounting for 1,5% to 5% of all dislocation cases observed in this area. The combination of a posterior dislocation with a humeral fracture is an even more unusual clinical occurrence.

   Clinical case: Patient R., a 54-year-old man, presented with complaints of pain and limited range of motion in both shoulder joints, which had suddenly developed about 3 weeks ago following a seizure that occurred after an episode of alcohol consumption. Computed tomography revealed bilateral posterior fracture-dislocations of both humeral bones. Bilateral posterior shoulder fracture-dislocations are extremely rare pathologies, most commonly associated with epileptic seizures or severe trauma. The main mechanisms of injury include direct trauma and excessive muscle effort. The diagnosis of such injuries is often delayed; however, a thorough patient history can raise suspicion of this pathology. Radiography is the key diagnostic method with pathognomonic signs, but computed tomography is preferred for better visualization. Treatment includes both conservative and surgical methods, depending on the severity of the injury and the patient's condition. Despite advances in imaging techniques, the diagnosis of posterior fracture-dislocation is often delayed by more than 6-12 months, which can significantly affect patient management strategies. A careful history-taking and timely radiological imaging can lead to an accurate diagnosis, thereby reducing the risk of recurrent instability.

1. Robinson, C.M. Posterior shoulder dislocations and fracture-dislocations / C.M. Robinson, J. Aderinto // The Journal of bone and joint surgery. American volume. – 2005. – Vol. 87(3). – P. 639-650.

2. Gosens, T. Posterior dislocation fractures of the shoulder in seizure disorders—two case reports and a review of literature / T. Gosens, P.J.E. Poels, J.J. Rondhuis // Seizure. – 2000. – Vol. 9(6). – P. 446-448.

3. Complex posterior fracture-dislocation of the shoulder. Epidemiology, injury patterns, and results of operative treatment / C.M. Robinson, [et al.] // The Journal of bone and joint surgery. American volume. – 2007. – Vol. 89(7). – P. 1454-1466.

4. Locked posterior dislocation of the shoulder / R.J. Hawkins [et al.] // Journal of Bone and Joint Surgery. – 1987. – Vol. 69-A. – P. 9–18.

5. Mynter, H. XIV. Subacromial dislocation from muscular spasm / H. Mynter // Annals of surgery. – 1902. – Vol. 36(1). – P. 117-119.

6. Brackstone, M. Triple “E” syndrome: Bilateral locked posterior fracture dislocation of the shoulders / M. Brackstone, S.D. Patterson, A. Kertesz // Neurology. – 2001. – Vol. 56(10). – P. 1403-1404.

7. Bilateral posterior fracture-dislocation of the shoulders following epileptic seizures : A case report and review of the literature / J. Pushpakumara [et al.] // BMC Res Notes. – 2015. – Vol. 8. – P. 704.

8. Shaw, J.L. Bilateral posterior fracture-dislocation of the shoulder and other trauma caused by convulsive seizures / J.L. Shaw // The Journal of bone and joint surgery. American volume. – 1971. – Vol. 53(7). – P. 1437-1440.

9. Rouleau, D.M. Incidence of associated injury in posterior shoulder dislocation : Systematic review of the literature / D.M. Rouleau, J. Hebert-Davies // Journal of orthopaedic trauma. – 2012. – Vol. 26(4). – P. 246-251.

10. Bilateral Locked Posterior Fracture-Dislocation of the Shoulder After Epileptic Seizures Secondary to Cavernous Hemangioma : A Case Report and Literature Review / A. Pangopoulos [et al.] // The American journal of case reports. – 2023. – Vol. 24. – e940141.

11. Arndt, J.H. Posterior dislocation of the shoulder / J.H. Arndt, A.D. Sears // The American journal of roentgenology, radium therapy, and nuclear medicine. – 1965. – Vol. 94. – P. 639-645.

12. Posterior shoulder fracture-dislocation: an update with treatment algorithm / Z.T. Kokkalis [et al.] // European journal of orthopaedic surgery & traumatology: orthopedie traumatology. – 2017. – Vol. 27(3). – P. 285-294.

13. Cautero, E. Locked bilateral posterior fracture-dislocation of the shoulder in an epileptic patient: case report / E. Cautero, E. Gervasi // Joints. – 2014. – Vol. 2(3). – P. 146-148.

14. Kasha, S. Bilateral Posterior Fracture-Dislocation of Shoulder Following Seizures Secondary to Cavernous Sinus Venous Thrombosis – A Rare Association / S. Kasha, G. Bandari // Journal of orthopaedic case reports. – 2018. – Vol. 8(4). – P. 49-52.

15. Osteochondral autograft and hemiarthroplasty for bilateral locked posterior dislocation of the shoulder / С. Torrens [et al.] // American journal of orthopedics (Belle Mead, N.J.). – 2012. – Vol. 41(8). – P. 362-364.

16. Epidemiology and specific features of shoulder injuries in patients affected by epileptic seizures / D. Cucchi [et al.] // Archives of orthopaedic and trauma surgery. – 2022. Vol. 143(4). – P. 1999-2009.