Bilateral Locked Posterior Fracture-Dislocation of the Shoulder After Epileptic Seizures Secondary to Cavernous Hemangioma: A Case Report and Literature Review

Patient: Male, 57-year-old Final Diagnosis: Bilateral locked posterior shoulder dislocation Symptoms: Shoulder pain Clinical Procedure: — Specialty: Neurosurgery • Orthopedics and Traumatology OBJECTIVE: Rare disease BACKGROUND: Posterior shoulder dislocation is an uncommon injury, accounting for less than 5% of all glenohumeral dislocations. Bilateral locked posterior shoulder fracture-dislocation is an extremely rare entity with an incidence of 0.6 cases/100 000 people/year. A few reports have been published in the literature, predominantly associated with epileptic seizures. CASE REPORT: We present a rare case of a 55-year-old male patient with a history of epileptic seizures, who presented with bilateral, locked, posterior fracture-dislocation of the shoulder following an epileptic seizure. The patient was diagnosed with a cavernous hemangioma, which caused his epileptic episode. He was treated operatively, with a modified McLaughlin procedure performed on both sides, at 1 stage, by 2 surgical teams. The cavernous hemangioma was also resected 2 months later. After a follow-up period of 18 months, no recurrent episodes of instability or dislocation were identified. Full range of motion was present on both sides, with good clinical and radiological outcomes. We also conducted a literature review to elucidate the causes of this rare incidence, along with diagnostic workup and treatment options. We were able to identify 36 cases, involving 72 shoulders of bilateral posterior fracture-dislocations in 30 case reports and 2 case series. CONCLUSIONS: Bilateral posterior fracture-dislocation of the shoulder is uncommon. Treatment strategy depends on the chronicity, involvement of the humeral head, and the patient’s age and functional level. The target is to restore shoulder anatomy and maintain a functional range of motion.