Near-simultaneous bilateral reverse total shoulder arthroplasty for the treatment of bilateral fracture dislocations of the shoulder

Abstract

A man in his mid-80s presented with bilateral posterior fracture dislocations of the humerus after suffering a seizure. He had Parskinson's disease and lived with his wife at home. His left shoulder was not felt to be reconstructable. The initial treatment plan was to perform reverse total shoulder arthroplasty (rTSA) on the left and non-operatively reduce his right shoulder. A left rTSA was performed, but his right shoulder was unstable due to a glenoid fracture and soft tissue instability. In order to preserve the patient's quality of life, a right rTSA was performed 4 days later. In the follow-up period, the patient was able to regain enough pain-free range of motion on activities of daily living. The patient died from complications of Parkinson's disease 10 months postoperatively.

Keywords: orthopaedic and trauma surgery; orthopaedics; shoulder instability.

Figure 1

(A) Anteroposterior (AP) and (B) lateral X-ray images of comminuted fracture of the surgical neck of the left humerus with superior migration of the humeral shaft and posterior displacement of the humeral head; while (C) AP and (D) lateral X-rays illustrate the right humeral surgical neck comminuted fracture with posterior displacement of the humeral head and inferior glenoid fracture.

Figure 2

AP and scapular Y views of left shoulder (A and B) and right shoulder (C and D) after reverse total shoulder arthroplasty.

Figure 3

Axial CT images of the right shoulder showing posterior (A) and inferior (B) glenoid fracture (arrows) that contributed to shoulder instability. This instability combined with the proximal humerus fracture ultimately led to the decision to perform reverse total shoulder arthroplasty.