Fractures of the proximal end of the humerus caused by convulsive seizures

doi:10.1016/S0020-1383(84)80009-1

Injury

Volume 16, Issue 2, 1984, Pages 108-109

https://doi.org/10.1016/S0020-1383(84)80009-1 Get rights and content

Summary

Fractures due to convulsions are known to occur. The purpose of this study was to find the frequency of convulsive seizures as the cause of fractures of the proximal end of the humerus, which are the most common of these fractures.

Of 278 cases admitted to the department, 2 per cent occurred after a seizure without other contributory causes. The manner of injury is discussed, and it is demonstrated that the diagnosis is often delayed. The importance of early reduction in cases with dislocation or displacement of the fracture is emphasized.

References (9)

O'FlanaganP.H.
Fracture due to shock from domestic electricity supply
Injury
(1975)
SalemM.I.
Bilateral anterior fracture dislocation of the shoulder joints due to severe electric shock
Injury
(1983)
CumminsJ.R.
Metrazol complications as affected by the use of curara
Can. Med. Assoc. J.
(1942)
DinK.M. et al.
Bilateral four-part fractures with posterior dislocation of the shoulder
J. Bone Joint Surg.
(1983)

There are more references available in the full text version of this article.

Cited by (22)

Poor midterm clinical outcomes and a high percentage of unsatisfying results are reported after seizure-related shoulder injuries, especially after posterior proximal humerus fracture-dislocations
2024, Journal of Shoulder and Elbow Surgery
Treating seizure-related shoulder injuries is challenging, and an evidence-based consensus to guide clinicians is lacking. The aim of this prospective single-center observational clinical trial was to evaluate the clinical results of a cohort of patients undergoing treatment of seizure-related shoulder injuries, to categorize them according to the lesion’s characteristics, with special focus on patients with proximal humerus fracture-dislocations (PHFDs), and to define groups at risk of obtaining unsatisfactory results. We hypothesized that patients with a PHFD, considered the worst-case scenario among these injuries, would report worse clinical results in terms of the quick Disabilities of the Arm, Shoulder, and Hand questionnaire (qDASH) as compared to the other patients.
Patients referred to a tertiary epilepsy center who have seizure-related shoulder injuries and with a minimum follow-up of 1 year were included. A quality-of-life assessment instrument (EQ-5D-5L), a district-specific patient-reported outcome measure (qDASH), and a pain assessment tool (visual analog scale [VAS]) were used for the clinical outcome evaluation. Subjective satisfaction and fear of new shoulder injuries was also documented. Categorization and subgroup analysis according to the presence and features of selected specific lesions were performed.
A total of 111 patients were deemed eligible and 83 were available for follow-up (median age 38 years, 30% females), accounting for a total of 107 injured shoulders. After a median follow-up of 3.9 (1.6-8.2) years, overall moderate clinical results were reported. In addition, 34.1% of the patients reported a VAS score ≥35 mm, indicating moderate to severe pain, and 34.1% a qDASH score ≥40 points, indicating severe disability of an upper limb. These percentages rose to, respectively, 45.5% and 48.5% in the subgroup of patients with PHFDs and to 68.8% and 68.8% in patients experiencing posterior PHFD. Overall, 46.9% of the patients considered themselves unsatisfied with the treatment and 62.5% reported a persistent fear of a new shoulder injury.
Patients with seizure-related shoulder injuries reported only moderate clinical results at their midterm follow-up. Older age, male sex, and absence or discontinuation of antiepileptic drug (AED) treatment were identified as characterizing features of patients with posterior dislocation episodes. In patients with PHFD, a tendency to worse clinical results was observed, with posterior PHFD patients emerging as a definite subgroup at risk of reporting unsatisfying results after treatment.
Seizure-induced thoracolumbar burst fractures — Not to be missed
2020, Epilepsy and Behavior Reports
Citation Excerpt :
In addition, the presence of a known intercranial tumor dominated his diagnostic work-up, further confounding the picture for causation of his neurological features. The second patient was initially misdiagnosed with a possible GBS, thus providing an incorrect etiology for his lower extremity weakness, as is the case when a patient's weakness is misdiagnosed as Todd's Paralysis [2]. Fractures are one of the most common injuries suffered during a seizure [1].
While rare, post-ictal thoracolumbar burst fractures are commonly missed due to confounding factors, resulting in delayed treatment and the potential for serious neurological deficits. This paper serves as a call for a high-degree of clinical suspicion when treating post-ictal patients to ensure they undergo a focused neurological examination of the lower extremities. If unresponsive/uncooperative, spinal precautions should be maintained until the spine can be cleared clinically or radiographically. In all events, if the patient is complaining of musculoskeletal pain possibly originating from the spine, radiographic evaluations are warranted to prevent possible deficits caused by a missed thoracolumbar fracture.
Unusual subclavian artery injury following clavicle fracture resulting from epileptic fit
2005, Injury Extra
Are spinal precautions necessary in all seizure patients?
1995, American Journal of Emergency Medicine
The purpose of this retrospective chart review study was to evaluate the necessity of spinal precautions in uncomplicated seizure patients. The population was all patients from the Emergency Department with a primary diagnosis of seizure over a 10.5-year period. The setting was a university-affiliated county teaching hospital with an annual patient volume of over 58,000. The key outcome measure was an association of spinal injuries to uncomplicated seizures. A total of 1,656 cases were reviewed. No spinal injuries were found. Three nonspinal fractures were associated with seizure activity. Transportation costs increased approximately 113% and nursing costs increased approximately 57% for patients with seizure placed in spinal precautions. Quality Assurance and Risk Management files showed no complaints or litigation secondary to missed spinal injuries. This retrospective chart review study seriously questions routine use of spinal precautions in uncomplicated seizure cases. If spinal precautions were not used in this group, there would be a significant potential cost savings without increased morbidity. A prospective study is needed to confirm these findings.
Epidemiology and specific features of shoulder injuries in patients affected by epileptic seizures
2023, Archives of Orthopaedic and Trauma Surgery
Lumbar compression fracture during major epileptic seizure
2021, Notfall und Rettungsmedizin

View all citing articles on Scopus

View full text

Fractures of the proximal end of the humerus caused by convulsive seizures

Summary

Injury

Injury

Metrazol complications as affected by the use of curara

Can. Med. Assoc. J.

Bilateral four-part fractures with posterior dislocation of the shoulder

J. Bone Joint Surg.