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Bilateral Anterior Shoulder Fracture-Dislocation-A Case Report And Review Of The Literature

*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


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, 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 :

  1. Lal M, Yadav RS, Prakash V. Bilateral anterior fracture dislocation shoulder--two case reports. Indian Journal of Medical Sciences 1992; 46(7):209-10

  2. 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.

  3. 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.

  4. 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. 

  5. 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  

  6. 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.

  7. Martens C, Hessels G Bilateral posterior four-part fracture-dislocation of the shoulder. Acta Orthop Belg. 1995;61(3):249-54.


This is a peer reviewed paper 

Please cite as : Suraj Bajracharya: Bilateral Anterior Shoulder Fracture-Dislocation-A Case Report And Review Of The Literature

J.Orthopaedics 2007;4(2)e2





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