Divergent Fracture-dislocation of Shoulders - A Therapeutic Challenge

Abstract

Introduction: Bilateral shoulder dislocations are rare and can result from sports injuries, epileptic seizures, electric shock, or electroconvulsive therapy. Divergent shoulder dislocations are even more rare and difficult to treat. We report a case of bilateral divergent shoulder dislocations with bilateral greater tuberosity fractures. We have reviewed the existing literature and have summarized the mechanisms and outcomes of such injuries.

Case report: A 35-year-old, right-hand dominant male, a known epileptic presented with pain and deformity in both shoulders after an episode of generalized seizures. Radiographs revealed anterior dislocation on the right and posterior dislocation on the left shoulders along with bilateral displaced fractures of the greater tuberosities. The patient was treated with closed reduction of bilateral shoulder dislocations using gentle traction followed by open suture fixation of the greater tuberosity fractures. The greater tuberosity on the posterior dislocation side needed redo fixation with compression screws and sutures for failed fixation. The patient went on to heal well and achieve full function. The case is one of a very rare group of injuries.

Conclusions: Divergent shoulder injuries with greater tuberosity fractures are very rare. They can present a diagnostic and therapeutic challenge. A higher degree of suspicion to diagnose and patient-based approach with strong fixation techniques can lead to good clinical outcomes.

Keywords: Shoulder dislocation; bilateral greater tuberosity fracture; bilateral shoulder dislocation; complex shoulder injury; divergent shoulder dislocation.

Figure 1

Anteroposterior and scapular Y radiographs of the right shoulder showing anteroinferior shoulder dislocation with greater tuberosity fracture.

Figure 2

Anteroposterior and scapular Y radiographs of the left shoulder showing posterior shoulder dislocation with greater tuberosity fracture.

Figure 3

Anteroposterior radiographs of both shoulders at 2 weeks demonstrating concentric reduction on both shoulders, but with greater tuberosity displacement on the left shoulder.

Figure 4

Anteroposterior and scapular Y radiographs of the left shoulder after revision fixation of greater tuberosity with cannulated screws.

Figure 5

Anteroposterior radiographs of the right and left shoulders at 12 months postoperatively demonstrating good union.

Figure 6

Bilateral shoulder function at 16 weeks postoperatively.