Bilateral Scapular Fractures Occurring as a Result of a First-Time Seizure

Abstract

The violent nature of generalized tonic-clonic seizures puts individuals at risk of a large number of potential injuries. These can occur due both to the profound muscular contractions that accompany these episodes as well as falls and other traumatic events that occur due to the period of loss of consciousness that occurs during generalized seizures. While injuries such as soft tissue contusions, tongue biting, dental injuries, and facial lacerations resulting from falls from standing predominate, bony injuries are not uncommon. We present a case of bilateral scapular fractures that occurred in an otherwise healthy 32-year male who presented with shoulder and back pain and inability to perform any significant movement of his upper arms secondary to pain after experiencing an apparent first-time generalized tonic-clonic seizure. The presence of unilateral and bilateral scapular fractures, while uncommonly described, should be considered as an additional potential orthopedic injury that may occur secondary to a generalized tonic-clonic seizure. In the absence of observed significant forceful traumatic injury, this injury is unusual, and its presence noted in a patient experiencing sudden loss of consciousness should raise heightened concern of seizures as the potential etiology.

Figure 1

Plain film radiographs of the right shoulder with no obvious right bony abnormalities noted. Left-sided scapular body fracture identified with intact glenohumeral joint.

Figure 2

Computed tomography (CT) imaging demonstrating bilateral scapular body fractures.

Figure 3

Standard CT and CT reconstruction image demonstrating more extensive left scapular body fracture.