Bilateral Reverse Total Shoulder Arthroplasty with Soft Tissue Release for Bilateral Posterior Fracture Dislocation after Status Epilepticus

Abstract

Proximal humerus fracture is a common orthopedic presentation, with bimodal age distribution. On the other hand, bilateral proximal humerus fracture dislocation is a rarely reported pathology, especially when it is not the result of direct trauma. We present a case of a 71-year-old female patient found to have simultaneous bilateral 4-part proximal humerus fractures following status epilepticus treated surgically with bilateral reverse shoulder arthroplasty with constraint and soft tissue release. In a patient with recurrent status epilepticus episodes, the combination of constrained reverse shoulder arthroplasty and the extensive soft tissue release should decrease the rate of failure and dislocation dramatically. We conclude, after reviewing the literature, that there is no straightforward algorithm for treating such patients and that a clear classification should take into account both bone quality and patient comorbidities which has yet to be developed.

Figure 1

(a) X-ray radiograph of the right shoulder showing a comminuted proximal humerus fracture. (b) X-ray radiograph of the left shoulder showing a comminuted proximal humerus fracture.

Figure 2

(a) CT of the right shoulder showing a comminuted displaced fracture of the proximal humerus. (b) CT of the left shoulder showing a comminuted displaced fracture of the proximal humerus.

Figure 3

(a) Postoperative X-ray radiograph of the right shoulder showing reverse shoulder arthroplasty. (b) Postoperative X-ray radiograph of the left shoulder showing reverse shoulder arthroplasty.