Bilateral shoulder fracture, dislocation and replacement: a first presentation of epilepsy
==========================================================================================

* Jonathan Richard White
* Altaf Palejwala

## Description

A 60-year-old gentleman presented with posterior, fracture-dislocations to both of his shoulders, secondary to undiagnosed epilepsy. Simple posterior dislocations are more commonly associated with seizures and so this case demonstrates a highly unusual first presentation. Shoulder x-rays on admission revealed bilateral comminuted fractures of the humeral head and neck. However, the complexity of this gentleman’s orthopaedic injuries was not fully appreciated until days later when CT imaging of his shoulders showed bilateral posterior dislocations in addition (figure 1). This case demonstrates that bilateral posterior shoulder dislocations are implicated with unwitnessed seizures. Therefore, a high index of suspicion of a seizure disorder must exist to ensure that there is no delay in the diagnosis and treatment of the underlying condition. With regard to treatment of the shoulder injury, early diagnosis and prompt surgical intervention is needed to determine a good outcome.1 2 In conclusion, the patient underwent bilateral shoulder arthroplasty and was started on lamotrigine. Six months post discharge, he continued to be seizure free and he re-gained good long-term function of his shoulders.

![Figure 1](http://casereports.bmj.com/https://casereports.bmj.com/content/casereports/2011/bcr.09.2011.4830/F1.medium.gif)

[Figure 1](http://casereports.bmj.com/content/2011/bcr.09.2011.4830/F1)

Figure 1 
(A, B) CT scan of shoulders–Demonstrating bilateral comminuted fractures of the humeral head and neck with posterior dislocation.

## Footnotes

*   Competing interests None.

*   Patient consent Obtained.

## References

1.  Tanner MW, Cofield RH. Prosthetic arthroplasty for fractures and fracture-dislocations of the proximal humerus. Clin Orthop Relat Res 1983;179:2–308.
    
    

2.  Robinson CM, Aderinto J. Posterior shoulder dislocations and fracture-dislocations. J Bone Joint Surg Am 2005;87:639–50.
    
    [CrossRef](http://casereports.bmj.com/lookup/external-ref?access_num=10.2106/JBJS.D.02371&link_type=DOI) 
    
    [PubMed](http://casereports.bmj.com/lookup/external-ref?access_num=15741636&link_type=MED&atom=%2Fcasereports%2F2011%2Fbcr.09.2011.4830.atom)