Bilateral Posterior Four-Part Fracture-Dislocation of the Proximal Humerus After First-Time Seizure

Abstract

This report presents a previously undescribed case and treatment of bilateral four-part proximal humerus (PH) fracture-dislocations presented in a 61-year-old Caucasian male patient following a first-time seizure episode. The patient was treated with bilateral reverse total shoulder arthroplasty due to pre-existing glenohumeral arthritis and rotator cuff atrophy. The surgery was successful, and the patient's postoperative recovery was uneventful. Fractures of the proximal humerus are a relatively common adult osteoporotic fracture; however, posterior fracture-dislocations of the PH, frequently related to motor vehicle accidents, seizures, or electrical shock, are remarkably scarce. A treatment algorithm for these injuries is lacking.

Keywords: bilateral proximal humerus fracture; bilateral shoulder arthroplasty; bilateral shoulder fracture-dislocation; four part fracture-dislocation; posterior dislocation of the shoulder; proximal humerus fracture; proximal humerus fracture-dislocation; reverse total shoulder arthroplasty; rtsa; seizure.

Figure 1. Axial view of preoperative computed tomography (CT) scan of the left shoulder demonstrating a four-part proximal humerus (PH) posterior fracture-dislocation.

Figure 2. Coronal view of preoperative CT scan of the left shoulder demonstrating a four-part proximal humerus (PH) posterior fracture-dislocation.

Figure 3. Sagittal view of preoperative CT scan of the left shoulder demonstrating a four-part proximal humerus (PH) posterior fracture-dislocation.

Figure 4. Axial view of preoperative CT scan of the right shoulder demonstrating a four-part proximal humerus (PH) posterior fracture-dislocation.

Figure 5. Coronal view of preoperative CT scan of the right shoulder demonstrating a four-part proximal humerus (PH) posterior fracture-dislocation.

Figure 6. Sagittal view of preoperative CT scan of the right shoulder demonstrating a four-part proximal humerus (PH) posterior fracture-dislocation.

Figure 7. AP postoperative radiograph of the left shoulder at 12 weeks demonstrates a reverse total shoulder arthroplasty (rTSA) in satisfactory alignment without signs of loosening or failure.

Figure 8. Scapular Y postoperative radiograph of the left shoulder at 12 weeks demonstrates a reverse total shoulder arthroplasty (rTSA) in satisfactory alignment without signs of loosening or failure.

Figure 9. AP postoperative radiograph of the right shoulder at 12 weeks demonstrates a reverse total shoulder arthroplasty (rTSA) in satisfactory alignment without signs of loosening or failure.

Figure 10. Scapular Y postoperative radiograph of the right shoulder at 12 weeks demonstrates a reverse total shoulder arthroplasty (rTSA) in satisfactory alignment without signs of loosening or failure.