Bilateral Proximal Humerus Fracture – a Rare Combination with a High Complication Rate after Surgery

Königshausen, Matthias; Rausch, Valentin; Mempel, Eileen; Glinski, Alexander von; Ull, Christopher; Bernstorff, Maria Alexandra; Schildhauer, Thomas A.; Seybold, D.; Geßmann, Jan

doi:10.1055/a-0619-6400

Cited by 5 publications

(2 citation statements)

References 34 publications

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“…Here, a vast spectrum of different shoulder injuries emerged, ranging from isolated unilateral soft tissue lesions to bilateral humeral fracture-dislocations, including acute and recurrent instability in both anterior and posterior direction. Notably, the percentage of patients suffering from “rare” injuries, such as posterior dislocations and bilateral shoulder lesions was confirmed to be higher compared to the literature data from cohorts without seizures [ 6 , 8 , 14 , 20 – 26 ].…”

Section: Discussionmentioning

confidence: 59%

“…Bilateral shoulder injuries are considered extremely rare and are found in literature almost always as case reports, associated with seizures [ 6 , 14 , 21 – 24 , 27 ], electrocution [ 25 ], or with high-speed motor vehicle accidents or falling on both arms [ 26 ]. A recent series investigated 17 surgically treated patients who sustained a bilateral humerus fracture caused either by falling on both arms or motor vehicle accident, without history of seizures: the reported average age was 68 years, notably higher than what we encountered in our subgroup of 13 patients who sustained a bilateral humeral fracture (age: 41.5 ± 13.0 years) [ 26 ]. When considering all our 29 patients experiencing bilateral injuries, mean age dropped to 33.6 years.…”

Section: Discussionmentioning

confidence: 99%

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Epidemiology and specific features of shoulder injuries in patients affected by epileptic seizures

Cucchi

Baumgartner

Walter

et al. 2022

Arch Orthop Trauma Surg

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Purpose Epileptic seizures can cause multiple shoulder injuries, the most common of which are dislocations, recurrent instability, fractures, and isolated lesions of the rotator cuff. Currently, only limited literature exists which describes the frequency and types of lesions in cohorts of epileptic patients and the corresponding treatment outcome. This study aims to document the occurrence of shoulder lesions in patients affected by seizures and to provide detailed information on trauma dynamics, specific lesion characteristics and treatment complications. Methods All patients referring to a tertiary epilepsy center were screened for shoulder injuries and the clinical records of those sustaining them during a seizure were reviewed. Demographic information, lesions’ characteristics and trauma dynamics were analysed, as wells as—when carried out—the type of surgical intervention and any postoperative complications. Results The average age at the time of injury of 106 included patients was 39.7 ± 17.5 years and a male predominance was recorded (65%). Bilateral injuries occurred in 29 patients, simultaneously in 17 cases. A younger age, bilateral shoulder injuries and shoulder dislocations were significantly associated with the occurrence of a shoulder injury solely by muscular activation (p = 0.0054, p = 0.011, p < 0.0001). The complication rate in 57 surgically treated patients with follow-up data was 38.7%, with recurring instability being the most frequently reported complication (62.5%). Conclusions Uncontrolled muscle activation during a seizure is a distinctive but not exclusive dynamic of injury in epileptic patients, accounting for more than the half of all shoulder lesions, especially in the younger. This can lead both to anterior and posterior dislocations or fracture-dislocations and is frequently cause of bilateral lesions and of instability recurrence after surgery. The high complication rates after surgical treatment in this selected subgroup of patients require that appropriate preventative measures are taken to increase the probability of treatment success. Level of evidence Cohort study, level III.

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Epidemiology and specific features of shoulder injuries in patients affected by epileptic seizures

Cucchi

Baumgartner

Walter

et al. 2022

Arch Orthop Trauma Surg

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Surgical management and results of glenohumeral combination fractures of the anterior glenoid rim and the proximal humerus

Kerkhoff,

Ull,

Rausch

et al. 2024

Arch Orthop Trauma Surg

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Introduction The combination of anterior large glenoid rim fractures (GRF) and proximal humerus fractures (PHF) is rare, with limited data available on specific treatments for these glenohumeral combination fractures (GCF). This study aimed to evaluate the treatment approaches for GCF, analyze patient outcomes, and outline surgical management strategies for different fracture types. Materials and methods This retrospective study included patients with GCF, excluding those with fossa glenoidalis fractures, isolated greater tuberosity fractures, or small glenoid rim fractures (< 5 mm). Preoperative radiographs, CT scans, and follow-up radiographs were reviewed. Clinical outcomes were assessed using the Constant-Murley Score (CMS), Western Ontario Shoulder Instability Index (WOSI), Rowe Score (RS), and Oxford Shoulder Score (OSS). Results Sixteen patients with 17 GCFs (mean age 62 years) were followed for an average of 39 months. PHFs were categorized into three-part (76%), four-part (12%), and two-part fractures (12%). The average medial displacement of GRF was 5 mm, with an average dehiscence of 4 mm in the sagittal plane. Fourteen patients (88%) underwent surgical treatment; 35% had only the PHF surgically addressed, while 53% had both lesions surgically treated. Two patients (12%) received non-operative treatment. Complications were observed in 29% of cases, primarily involving the humeral side. The average CMS was 68 points, WOSI was 75%, RS was 77 points, and OSS was 41 points. Conclusion Treating GCF is complex and routinely necessitates surgical intervention, with or without GRF refixation. CT imaging is crucial for precise assessment of fracture morphology. The involvement of the minor tuberosity is critical in selecting the optimal surgical approach and managing the subscapularis muscle.

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Combined fractures of the humeral head and the glenoid

et al. 2019

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Background. Glenohumeral combination fractures are severe shoulder injuries for which, however, few data are available in the literature. The aim of the study was to analyze the incidence and numeric distribution of glenohumeral combination fractures using a classification system. Furthermore, treatment methods and complications are discussed. Methods. This retrospective study is based on the data evaluation of a level I trauma center between 1998 and 2016. Glenohumeral combination fractures are classified into four types, and the incidence, treatment method, and complications are evaluated. Additionally, the fracture morphology and displacement of the different fracture types are analyzed.

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Bilateral Proximal Humerus Fracture – a Rare Combination with a High Complication Rate after Surgery

Abstract: Bilateral proximal humerus fractures are mainly associated with comminuted displaced fractures and a higher complication rate in comparison to monolateral fractures after surgical treatment.

Cited by 5 publications

References 34 publications

Epidemiology and specific features of shoulder injuries in patients affected by epileptic seizures

Epidemiology and specific features of shoulder injuries in patients affected by epileptic seizures

Surgical management and results of glenohumeral combination fractures of the anterior glenoid rim and the proximal humerus

Combined fractures of the humeral head and the glenoid

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