Asymmetrical Fracture Dislocation of Shoulder - A Case Report and Review of Literature.

ABSTRACT

INTRODUCTION: A bilateral shoulder dislocation is an extremely rare injury with only a few reported cases in English literature, and most of these cases have occurred following a seizure episode or an electric shock. We present the first ever reported case of simultaneous bilateral anterior and posterior fracture dislocation of shoulders and its unique mechanism of injury in a 48 year old diabetic male. CASE REPORT A 48 year old male presented to our emergency department with pain and restriction of movements involving both shoulders following a fall. The patient was standing by the side of a two wheeler when he had a sudden syncopal attack and toppled on the other side of the vehicle. On examination there was flattening of deltoid contour with a positive Dugas test in both sides. Humeral head was palpable posteriorly on the right side and anteriorly on the left side. Plain radiograph anteroposterior view of both shoulders showed posterior dislocation of right shoulder with a fracture of greater tuberosity and anterior dislocation of left shoulder with a greater tuberosity fracture. Closed reduction was achieved for both shoulders under general anaesthesia. After a couple of weeks, complete range of motion exercises was started. X-ray of bilateral shoulders, at 3 months, showed complete union of the fracture. CONCLUSION: Bilateral shoulder dislocation is suspected only following a violent mechanism of injury, however, we would like to point out, giving an example of our case that this injury may also occur after a trivial fall. And if associated with a fracture sometimes, the characteristic attitude of the limb may not be seen leading to a missed diagnosis. However a thorough clinical examination and the knowledge that such injuries may occur after a simple fall will help prevent missing these injuries.