Bilateral Scapular Fracture due to an Epileptic Seizure: A Case Report

Abstract

Introduction: Bilateral scapular fractures are a very rare injury with only few cases reported in the literature. They are said to be consequence of a violent trauma to the upper part of shoulder or as a result of electrocution or seizures. Glenoid involvement or open scapular fractures are one of the indications for operative treatment in these injuries, in other cases, simple immobilization is sufficient to obtain good results. Here, we report a case of a bilateral scapular fracture following an epileptic seizure, discussing the mechanism and outcome of conservative treatment.

Case report: A 450-year-old healthy man with new-onset seizure with upper backache and bilateral shoulder pain, X-ray, and computed tomography (CT) with 3D reconstruction confirmed fracture of neck and body of bilateral scapula. Treatment consisted of immobilization with simple sling for both shoulders for 4 weeks, followed by early rehabilitation by pendular movements then gradually passive and active exercises of amplitude crossing were started at week 3. At 12-month follow-up, there was good clinical and radiological evolution with good resumption of activities.

Conclusion: Bilateral scapular fracture is a rare injury. Scapular fractures should be considered a potential etiology for shoulder and upper back pain following seizure activity. Scapular fracture can be missed easily on plain radiographs. Hence, CT scan with 3D reconstruction is very important in such cases. Treatment of the majority of scapular fractures without intraarticular extension remains to be conservative by simple immobilization. Surgical fixation is reserved for fractures at risk of joint complications or open lesions that would require surgical treatment, because of their long-term functional impact.

Keywords: Scapular fracture; bilateral scapular fracture; epilepsy; seizures.

Figure 1

Computed tomography within 3D reconstruction showing the comminuted fracture of the body of the scapula on the left and right.