DOI: 10.1016/j.jcot.2018.08.018
In a groundbreaking case that has captivated the orthopedic community, doctors at Apollo Hospitals, Bilaspur, India, documented an exceedingly rare presentation of bilateral luxatio erecta with concomitant bilateral greater tuberosity fractures following an epileptic seizure in a young Indian male patient. This article examines the rarity, management, and diagnostic challenges of this case, as well as the therapeutic outcomes and implications for best orthopedic practices.
Keywords
1. Luxatio Erecta Bilateral
2. Shoulder Dislocation Seizure
3. Greater Tuberosity Fracture
4. Epileptic Seizure Orthopedic Injury
5. Inferior Shoulder Dislocation Management
The Uniqueness of the Case
Luxatio erecta, the inferiormost form of shoulder dislocations, is a topic of high clinical intrigue due to its rarity. Bilateral occurrence paired with greater tuberosity fractures escalates its rarity even further. With only a handful of such cases documented in medical history, the instance reported by Reddy et al. (2020) stands as a testament to both the unpredictable nature of seizure-related injuries and the complexity of their management.
Clinical Manifestations and Diagnostic Conundrums
Upon admission, the patient presented with hyperabducted arms fixed above his head, a characteristic posture associated with luxatio erecta, which prompted immediate clinical suspicions. Diagnostic imaging was essential in confirming the diagnosis and ascertaining the gravity of the concomitant fractures, as outlined in a review by Saxena and Pradhan (2013). Given the clinical dilemma, a thorough radiological assessment was imperative to devise an appropriate treatment strategy.
Therapeutic Approaches and Challenges
Anesthesia and cautious manipulation were the foundations of the reduction technique employed to address the dislocations, as echoed by similar procedures described by Seo and Min (2009). Addressing the fractures, however, required a more nuanced approach due to their bilateral nature and potential impact on shoulder mechanics – a clinical challenge previously explored by researchers such as Burke (1991).
Thoughtful Refinement of Treatment Protocols
The Apollo Hospital team, well-versed with Neer’s four-segment classification of proximal humeral fractures (2002), applied best-in-class orthopedic principles to accommodate the dual nature of the injury. Conservative management for the lesser tuberosity fracture and surgical intervention on the greater tuberosity fracture were considered, taking cues from Bono et al.’s research on the mechanics of shoulder fractures (2001).
Outcomes and Clinical Implications
With a successful reduction of the dislocation and management of the fractures, the patient demonstrated commendable postoperative recovery. Long-term prognoses highlight the need for diligent rehabilitation to restore optimal shoulder function, an aspect underscored by the work of Yin et al. (2012). Notably, the Apollo Hospital case fuels the discourse on the tailored management of complex, multifaceted orthopedic trauma.
References
1. Saxena V., Pradhan P. (2013). Bilateral luxatio erecta with greater tuberosity fracture: a case report. Journal of Clinical Orthopaedics and Trauma, 4(4), 185–189. doi: [10.1016/j.jcot.2021.01.010]. PMC3880949
2. Seo J., Min B. (2009). Bilateral inferior shoulder dislocation with greater tuberosity fracture – a case report. J Korean Orthop Assoc., 44(4), 490.
3. Neer C. (2002). Four-segment classification of proximal humeral fractures: purpose and reliable use. J Shoulder Elbow Surg., 11(4), 389–400. PMID: 12195260
4. Mawby J., Saha A., Wright S., O’Connor P., Templeton P. (2005). Unusual presentation of an inferior fracture dislocation of the shoulder in a child following seizure activity: a case report and discussion. Inj Extra., 36(11), 483–485.
5. Burke F. (1991). Classification of fractures of long bones. J Hand Surg: Journal of the British Society for Surgery of the Hand., 16(2), 228–229.
6. Bono C., Renard R., Levine R., Levy A. (2001). Effect of displacement of fractures of the greater tuberosity on the mechanics of the shoulder. J Bone Joint Surg., 83(7), 1056–1062. PMID: 11603523
7. Yin B., Moen T., Thompson S., Bigliani L., Ahmad C., Levine W. (2012). Operative treatment of isolated greater tuberosity fractures: retrospective review of clinical and functional outcomes. Orthopedics., 35(6), e807–e814. PMID: 22691650
Conclusion
The case reported by Reddy et al. from Apollo Hospitals is an essential addition to the scarce clinical narratives on bilateral luxatio erecta with bilateral greater tuberosity fractures. As a significant contributor to modern orthopedic literature, it reinforces the importance of a collaborative, multi-dimensional approach to the management of rare and complex dislocations. Orthopedic professionals would benefit from this case by understanding the nuances of managing epilepsy-related orthopedic trauma, thereby enhancing patient care in similar future scenarios.