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*Suraj
Bajracharya, Pankaj Kumar,nM P Singh
#Department
of Orthopaedics, B P Koirala Institute of Health Sciences , Dharan,
Nepal
Address for Correspondence
Dr Suraj
Bajracharya,
Department of Orthopaedics
B P Koirala Institute of Health Sciences,
Dharan, Nepal
E-Mail: drsurajbajra@hotmail.com
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Abstract
We report a rare case of bilateral anterior
shoulder fracture-dislocation following road traffic accident
with unusual type of mechanism of injury leading to symmetrical
and identical injury to both shoulders. Previously reported
cases were either of bilateral dislocations or bilateral
fracture dislocations of asymmetrical nature. A review of the
literature is presented.
J.Orthopaedics 2007;4(2)e22
Case Report
 A
23 year old bus conductor, from Sunsari Dharan presented to
severe pain, deformity and unable to move his both upper limbs
for 12 hrs duration due to road traffic accident. He sustained
injury to both shoulder due to overturn of bus twice while
falling from the side of road of about 30 feet. He was standing
on the bus with both the hand holding the iron bar on the roof
of the bus on passenger way and his foot was entrapped in
between the iron beam and seat. He felt an excruciating pain on
both the shoulder and became unconscious for a while. There were
no external wounds and associated
injuries in other part of the body. Thenafter he could
not move his both  upper
limb. On examination his both shoulder were abducted, externally
rotated and there was a huge swelling with ecchymosis on the
anterior-medial aspect of shoulder at anterior axillary fold as
shown in Fig (1). On radiographs, there was fracture-dislocation
of shoulder on both sides. The fracture of greater tuberosities
on both sides was present as shown in Fig (2)
Under
General Anesthesia, closed reduction was done with Rockwood’s
method (Traction-counter
 traction method) and arm chest
immobilizer was applied. The check radiograph was acceptable as
shown in Fig (3). Both shoulders were immobilized for 3 weeks.
After 3 weeks, graded physiotherapy was started with restricted
movement of abduction and external rotation. On 3 months follow
up, he had only terminal restriction of movement of both
shoulders. He had no complains at the last follow up at 6th
months.
Discussion :
Bilateral
anterior fracture dislocation is very rare1 2. Whereas we can
find lot of cases of posterior fracture dislocation shoulder
caused by different known causes like road traffic accident,
epileptic seizures, electricity etc in the literature. 26
reported cases of bilateral posterior fracture-dislocation of
the shoulders in the literature was mentioned by Page AE et al.3
Lal M et al
reported rare cases of bilateral anterior fracture dislocation
of shoulder from Himachal Pradesh, India. 1
Dinopoulos HT et al reported an unusual case of bilateral anterior
shoulder dislocation following trauma. They mentioned that
previously reported cases were either of bilateral dislocations
or bilateral fracture dislocations. In their case the patient
suffered bilateral anterior dislocation with asymmetrical type
of injury.2
Page AE et al presented the case of a patient who sustained
bilateral posterior fracture-dislocations after a first time
seizure. Due to significant articular surface involvement,
bilateral hemiarthroplasties were performed. The literature on
this injury and current treatment options were reviewed.3
Seizures
are sometimes the first manifestation of a brain tumour. They
may give rise to shoulder fractures or fracture-dislocations.
When bilateral, these lesions tend to be symmetrical. The
patient reported here suffered from a previously undiagnosed
brain tumour, the first manifestation of which were seizures,
which provoked a bilateral shoulder dislocation in opposite
directions. The posterior dislocation was recognized with a
delay of 16 days. After an episode of seizures, shoulder
dislocation can occur in either direction, and bilateral
shoulder dislocations may not be symmetrical.4
Bilateral simultaneous shoulder fractures are usually the
consequence of a severe trauma, as in road accidents, falls,
high-energy traumas, and electroconvulsive therapy employed in
the treatment of severe mental disorders, when patients are
given electric shocks to the brain to make them have
convulsions. All such injuries cause the fractures by direct
trauma, when the shoulders are beaten against a hard surface.
High-voltage
electrical and lightning injuries can produce shoulder fractures
by a dual effect, i.e.direct trauma secondary to a fall and
violent muscle contraction. These electrical injuries usually
present certain signs, such as entry and exit burns and loss of
consciousness, and severe complications6 may appear, such as
acute renal failure, associated skeletal and central nervous
system injuries, and cardiac alterations. The severity of the
injury depends on the intensity of the electric current, the
pathway it follows through the body, and the duration of contact
with the source of the current.5
The
case of a 39-year-old man is presented, who sustained a
bilateral locked fracture dislocation of the shoulders occurring
during an epileptic seizure. Radiographs demonstrated a
compression-fracture of the anteromedial aspect of the humeral
head bilaterally (reversed Hill-Sachs-lesions). Additionally,
fractures of the lesser and greater tuberosity were diagnosed at
the right site. Open reduction and internal fixation was
performed in both shoulders within 12 hours. 6 months later the
patient has no complaints with a free range of motion.
Diagnostics, treatment and result are discussed in context with
the literature. 6
Reference :
-
Lal M, Yadav RS, Prakash V. Bilateral anterior fracture
dislocation shoulder--two case reports. Indian Journal of
Medical Sciences 1992; 46(7):209-10
-
Dinopoulos HT,
Giannoudis PV,
Smith RM,
Matthews SJ. Bilateral anterior shoulder fracture-dislocation. A case report and a
review of the literature.
Int
Orthop. 1999;23(2):128-30.
-
Page AE,
Meinhard BP,
Schulz E,
Toledano B. Bilateral posterior fracture-dislocation of the shoulders: management by
bilateral shoulder hemiarthroplasties.
J
Orthop Trauma. 1995;9(6):526-9.
-
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
Dec;70(6):612-5.
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Elena-Sorando E., Agulló-Domingo A., Juan-Garcia E.,
Amrouni B. Bilateral shoulder fractures secondary to accidental
electrical injury. Annals of Burns and Fire Disasters. March
2006 vol. XIX - n. 1
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Engel T,
Lill H,
Korner J,
Josten C. Bilateral
posterior fracture-dislocation of the shoulder caused by an
epileptic seizure - diagnostic, treatment and result.
Unfallchirurg. 1999 Nov;102(11):897-901.
-
Martens C,
Hessels G Bilateral posterior four-part fracture-dislocation of the shoulder.
Acta
Orthop Belg. 1995;61(3):249-54.
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