Bilateral Divergent Fracture Dislocations in a COVID-19 Patient Following a Hyponatremia-Induced Seizure

Abstract

Bilateral divergent fracture dislocations of the shoulder are very rare. Caution with regards to seizure development in COVID-19 patients must be taken to avoid such injuries. This is the case of a male COVID-19 patient who sustained hyponatremia-induced seizure that resulted in bilateral divergent shoulder fracture dislocations. The patient suffered a lesser tuberosity fracture on his left shoulder which was posteriorly dislocated, and a greater tuberosity fracture on his right, which was anteriorly dislocated. The patient underwent bilateral open reduction and internal fixation, with suture anchor fixation for the lesser tuberosity fracture on the left side, and a proximal humerus locking plate for the greater tuberosity fracture on the right side. Education on postoperative complications and expectations were provided to the patient.

Keywords: Greater tuberosity; Lesser tuberosity; Locking plate; Suture anchor fixation.

Figure 1

Figure 1: X-ray imaging of the patient at presentation confirming a posterior dislocation of the left shoulder (a) and an anterior dislocation on his right side (b)

Figure 2

CT imaging of the left shoulder showing a comminuted displaced lesser tuberosity fracture. There is extension of the fracture line towards the greater tuberosity and into the anatomic neck

Figure 3

CT imaging of the right shoulder showing a comminuted displaced greater tuberosity fracture. The fracture showed inferior and posterior positioning, with mild extension into articular surface

Figure 4

Intraoperative images of repair of lesser tuberosity fracture on the left side using suture anchor fixation through a limited subscapularis split (a), and repair of greater tuberosity fracture on the right side using proximal humerus locking plate (b)

Figure 5

X-ray imaging at 3 months post-surgery showing appropriate fixation and reduction of the greater tuberosity on the right shoulder (A), and the lesser tuberosity fracture in the left shoulder (B)