Neglected bilateral posterior shoulder fracture dislocation in an uncontrolled seizure patient

Posterior dislocation of the shoulder is a rare injury that occurs secondary to trauma and seizures. Diagnosis is often missed and treatment is challenging. Neglected posterior dislocation is associated with Hill-Sachs lesion which leads to locking of dislocation. Correct diagnosis is achieved by history taking, a physical examination and appropriate imaging. In neglected shoulder dislocation with uncontrolled seizure and humeral head defects of up to 45% the McLaughlin procedure shows excellent results at follow-up

importance of full spinal cord screening and assessment of trauma patients involved in motor vehicle accidents: a case report

Traumatic spinal cord injury due to motor vehicle accidents is the predominant reason for emergency room visits in central Saudi Arabia1 and developed countries.2 If head and neck trauma is suspected, then cervical spine imaging is commonly performed to rule out spinal fracture.3 But in instances where there seems to be mild trauma, the remainder of the spine is not imaged.3 The proceeding case is about a 45-year-old motor vehicle accident survivor with a history of ankylosing spondylitis. Initial clinical examination revealed an apparent mild traumatic spinal injury without a cervical-spine fracture. To the attending physicians, this finding did not warrant for a thorough neurological examination along with a full imaging scan. Radiography of the thoracic spine was not performed until it became clear that there were symptoms suddenly emerging after patient stabilization. By that time however, it was too late: an undisclosed thoracic spine fracture caused significant spinal cord compression, and this in turn led to complete paraplegia. We therefore emphasize that all trauma survivors of road traffic accidents undergo a comprehensive spinal cord scanning and assessment, regardless of the initial severity and symptomology of the injury

importance of imaging for status epilepticus patients to rule out fractures - a case report

Status epilepticus could be the first presentation of underlying epilepsy or may occur in patients with known epilepsy. The literature has reported many cases of seizures severe enough to cause dislocations or fracture-dislocations of the shoulder or hip joints and death from hemorrhaging. Although shoulder and hip injuries due to seizures are rare, such events are known to occur, especially in patients with a history of osteoporosis or other risk factors for fractures. We describe a case of a 35-year-old healthy male with no history of osteoporosis or reduced bone density. His first presentation of epilepsy manifested with status epilepticus. This prolonged seizure resulted in bilateral acetabular fracture with left proximal humerus fracture without any trauma or falls. Although fractures associated with seizures have been reported in the literature, dislocation and fractures from seizures involving both the hip and the shoulder joints have only been described in a few cases. Two of these cases involved patients with known epilepsy, osteoporosis and osteomalacia. To the best of our knowledge, this is the first described case of a patient with bilateral hip and one shoulder fracture that had no previous history of epilepsy or seizures, except for febrile seizure as a child, which did not requiring any treatment. He was also not taking any antiepileptic medications, which are known to reduce bone density. This case shows the severity of status epilepticus and the importance of screening for fractures in patients, especially in those with risk factors for reduced bone density