Bilateral posterior fracture - dislocation of the shoulders after epileptic seizure in patients with cerebral meningiomas. Triple E syndrome – Review of the literature

Bilateral posterior fracture-dislocation of the shoulders is a very rare entity with an average rate of 0.6/100000 per year. It was first described in 1902 by Mynter. Only a few cases have been published so far. The “triple E syndrome" is used to describe the causative factors involved in this injury – epilepsy, electrocution, extreme trauma. We present our experience since 2019 with 2 cases of bilateral posterior fracture-dislocation of the shoulders after an epileptic seizure in patients with cranial meningiomas. Total removal of the meningiomas was performed in both cases and afterwards the patients were operated on by the traumatology team. The shoulder joint is the most commonly dislocated joint in the body with less than 4 % being posteriorly dislocated. Bilateral fracture-dislocation of the shoulders is associated with “triple E syndrome" and 90 % of the cases are related to seizures. The diagnosis is usually delayed due to the lack of signs of trauma. Early diagnosis and proper surgical treatment can maximize the final functional results and patient recovery.