Bilateral posterior fracture-dislocation of the shoulders with subscapularis rupture and HAGL lesion: a case report

Background: Bilateral posterior fracture-dislocation of the shoulders is a rare condition and easy to be overlooked.They can be caused by epileptic seizures, sports injuries, electrical shock, or electroconvulsive therap.We report a rare case of posterior fracture-dislocation of bilateral shoulders with the HAGL (Humeral Avulsion Glenohumeral Ligament) lesion on one shoulder, and subscapularis rupture on the other shoulder during a seizure attack in epileptics.Case presentation: A 69-year-old male was admitted to our hospital two days after an epileptic seizure.Clinical examination showed severe pain and limited range of motion in both shoulders.The shoulder radiograph examination revealed the great tuberosity fractures and 'light bulb sign' bilaterally.CT examination showed glenohumeral joint fractures and posterior dislocations in bilateral shoulders.After immediate close reduction, MRI was performed.This showed comminuted fractures of the both humeral heads and necks, reverse Hill-Sachs lesions, complete subscapularis rupture on the left shoulder, and HAGL lesion on the right shoulder.We performed open reduction internal fixation of fractures, repair of subscapularis, and repair of HAGL lesion.At six month, the patient showed excellent outcome. Conclusion:We treated successfully bilateral posterior fracture-dislocation of shoulders with subscapularis rupture and HAGL lesion after an epileptic seizure episode.As far as we know, this is the first report of this complicated condition.Not only physical examination and radiographic evaluation are important, but also MRI exam to investigating soft tissue injuries was one of the key points of this case.Open reduction internal fixation of fractures and reconstruction of ligaments followed by a rehabilitation program to address shoulder instability lead to a successful result.