Bilateral proximal humerus fractures induced by seizure and electrocution: Two case reports with literature review

A bstract Bilateral proximal humerus fractures are rare and usually result from high-energy trauma, seizure-induced muscle contractions, or electrical injury. Electrical injury may cause violent involuntary muscle contractions, resulting in fractures even in the absence of a fall. These injuries can be missed because the initial evaluation often focuses on burns, cardiac complications, and neurological deficits. Early recognition and timely surgical treatment are therefore essential to prevent long-term disability. Here, we report two cases of bilateral proximal humerus fractures: one following a generalized tonic–clonic seizure and the other after high-voltage electrocution. Both patients were evaluated with radiographs and computed tomography scans, and the fractures were classified according to the Neer classification. Both patients underwent bilateral open reduction and internal fixation using proximal humerus internal locking system plates, followed by a structured rehabilitation protocol. Both patients achieved good functional recovery after surgery. In the seizure-related case, the Constant–Murley score (CMS) was 75 on the right side and 95 on the left side at 18 months, with satisfactory shoulder function. In the electrocution-related case, the CMS was 90 on the right side and 92 on the left side, with forward flexion exceeding 160° bilaterally. No major complications, including implant failure, nonunion, or avascular necrosis, were observed. Bilateral proximal humerus fractures following seizures or electrical injuries are uncommon but clinically important orthopedic emergencies. A high index of suspicion, early imaging, timely surgical intervention, and multidisciplinary rehabilitation can substantially improve functional outcomes.