A unique case of non- traumatic asymmetric shoulder dislocation with four-part fractures of proximal humeri following seizures.

Sir,

Asymmetric (simultaneous anterior and posterior) shoulder dislocations are rare. To the best of our knowledge only five cases of asymmetric shoulder dislocations have been reported worldwide.[12345] None of these cases were associated with four-part fracture of proximal humeri. Musculoskeletal injuries following seizures are frequently missed.[1] The case presented here is of a post-seizure asymmetric fracture dislocation of shoulder with missed initial diagnosis. A 50 year old man presented to us in the outpatient department with complaints of pain and restriction of movements of both shoulders three weeks subsequent to seizures. The patient was seen at a nearby health care facility where apparently, the shoulder injury was missed. Radiograph of both shoulders showed anterior dislocation with four-part fracture of the proximal humerus on the right side and posterior dislocation with four-part fracture of the proximal humerus on the left side. A computed tomography (CT) scan of both shoulders with three-dimensional reconstruction confirmed this injury [Figures 1-3].

Figure 1

Three-dimensional CT scan right shoulder

Figure 3

CT scan transverse section showing asymmetric shoulder dislocation

Three-dimensional CT scan left shoulder

Serious musculoskeletal injuries like fractures have been associated with seizures. These include fractures around shoulder, pelvis, spines, neck of femur and dislocation of temporomandibular joint.[6] We feel that this case is worth reporting because of several reasons. Firstly, patient sustained asymmetric fracture dislocation of shoulder after seizures which are rare. Secondly, both shoulder dislocations were associated with four-part fracture of proximal humeri, which has not been reported so far. Thirdly, this patient sustained non-traumatic anterior fracture dislocation of shoulder, which again is very uncommon as anterior fracture dislocations are usually due to trauma. This case further highlight that serious musculoskeletal injuries can result because of seizures and should be looked for.