Bilateral Scapular Fracture due to an Epileptic Seizure: A Case Report

Introduction

Bilateral scapular fractures are a very rare injury with only few cases reported in the literature. They are said to be consequence of a violent trauma to the upper part of shoulder or as a result of electrocution or seizures. Glenoid involvement or open scapular fractures are one of the indications for operative treatment in these injuries, in other cases, simple immobilization is sufficient to obtain good results. Here, we report a case of a bilateral scapular fracture following an epileptic seizure, discussing the mechanism and outcome of conservative treatment.

Case Report

A 450-year-old healthy man with new-onset seizure with upper backache and bilateral shoulder pain, X-ray, and computed tomography (CT) with 3D reconstruction confirmed fracture of neck and body of bilateral scapula. Treatment consisted of immobilization with simple sling for both shoulders for 4 weeks, followed by early rehabilitation by pendular movements then gradually passive and active exercises of amplitude crossing were started at week 3. At 12-month follow-up, there was good clinical and radiological evolution with good resumption of activities.

Conclusion

Bilateral scapular fracture is a rare injury. Scapular fractures should be considered a potential etiology for shoulder and upper back pain following seizure activity. Scapular fracture can be missed easily on plain radiographs. Hence, CT scan with 3D reconstruction is very important in such cases. Treatment of the majority of scapular fractures without intraarticular extension remains to be conservative by simple immobilization. Surgical fixation is reserved for fractures at risk of joint complications or open lesions that would require surgical treatment, because of their long-term functional impact.

Post-traumatic bilateral scapular and thoracic vertebral body fractures - a case report

The simultaneous fracture of both scapulae with coexisting fracture of the thoracic vertebral body is observed extremely rarely and is fully dependent on the mechanism that caused them.

A CASE REPORT

The 59-year-old patient was admitted to the trauma and orthopedic department because of back pain and the inability to move independently. A few hours earlier he suffered bludgeoning trauma from a thick branch falling from a tree. During the physical examination significant limitation the range of motion in shoulder joints with was found. <15 ° flexion and <30 ° abduction, with limited external rotation in the right shoulder joint, and <15 ° flexion and <15 ° abduction, with significant external rotation deficiency. Normal range of motion in both hands was preserved. No sensory deficits or paresis were observed. Radiographic examination revealed the presence of a multifragmentary fracture of both scapulae and a fracture of the Th9 vertebral body, which was confirmed by computed tomography of the chest. The patient was qualified for conservative treatment of scapular fractures and was fitted with an abduction splint for the left shoulder. The Th9 vertebral body required surgical approach. The patient underwent transpedicular stabilization of the Th7,8,9,10 vertebrae with precontoured rods for the kyphotic deformation of the spine. After the procedure, the patient was provided with Javette's brace strengthening the spine correction and discharged for further outpatient observation.

CONCLUSIONS

Fracture of the scapula is one of the most demanding fractures to diagnose in the classic radiological examination. CT scans with 3D reconstruction can be considered to be the "gold standard". Surgical procedures is indicated for patients with severe comminution of fracture fragments and neurological symptoms. Minor fracture displacements can be conservatively treated. Coexisting Th9 vertebra fracture in this case required surgery by posterior transpedicular stabilization.