Publication:

A case of neglected bilateral anterior fracture dislocation of shoulder following seizure episode in a young schizophrenic patient treated with open reduction and internal fixation: a case report

Bilateral shoulder injuries especially fracture dislocations are rare injuries and pose significant diagnostic and therapeutic challenges, especially in patients with psychiatric comorbidities. This report describes the successful management of bilateral anterior shoulder fracture dislocations with comminuted greater tuberosity and proximal humerus fractures in an adult patient with schizophrenia following the first-episode of a seizure. Even though anterior fracture dislocations with greater tuberosity fractures have been reported, cases of bilateral neglected anterior fracture dislocations involving greater tuberosity and proximal humerus with a displaced humeral head have never been reported. Our case report emphasises the importance of attempting anatomical reduction and stable fixation of both bony and soft tissue elements to achieve good clinical outcomes even in chronic injuries. This patient who was in his late twenties, on regular medication for schizophrenia presented to the Emergency room 10 days following the first episode of a generalised tonic clonic seizure with pain, swelling and deformity of both shoulders. On clinical and radiological evaluation, he had features suggestive of bilateral anterior fracture dislocations. He underwent greater tuberosity avulsion repair using suture anchors on the left and open reduction internal fixation with a PHILOS plate, cannulated screws and additional soft-tissue repairs on the right. The patient went on to have an excellent clinical outcome. This case underscores the importance of high clinical suspicion for bilateral shoulder injuries in patients on psychotropic medication with seizure episodes, meticulous surgical technique and involvement of multidisciplinary care to yield favourable outcomes in rare complex shoulder injury patterns.