A Systematic Review of the Management of Upper Extremity Orthopaedic Injuries in Epileptic Patients



1 Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York, USA

2 Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA

3 1 Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York, USA 3 Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston MA


Background: During seizures, injury of the upper extremities may occur. Standardized guidelines are deficient for 
diagnosis and perioperative care. 
Methods: PubMed, Embase, Cochrane, Scopus, and Web of Science databases were systematically screened 
using predefined search terms. 
Results: Of the 59 patients included, 36 (61.0%) involved a posterior shoulder dislocation. Associated fractures were 
observed in 34 (57.6%) cases with surgical procedures performed in 30 (50.8%) patients. Functional outcomes were 
reported in 44 patients, with over half (23 of 44, [52.2%]) endorsing range of motion deficits. 
Conclusion: Standardized guidelines, to guarantee timely management of injury in post-seizure patients, are 
needed with a customized treatment approach that accommodates the various aspects of their condition.
Level of evidence: II


1. Robinson CM, Aderinto J. Posterior shoulder 
dislocations and fracture-dislocations. J Bone Joint 
Surg Am. 2005;87(3):639-50.
2. Cicak N. Posterior dislocation of the shoulder. J Bone 
Joint Surg Br. 2004;86(3):324-32.
3. Hatzis N, Kaar TK, Wirth MA, Rockwood CA, Jr. 
The often overlooked posterior dislocation of the 
shoulder. Tex Med. 2001;97(11):62-7.
4. Langenbruch L, Rickert C, Gosheger G, Schorn D, 
Schliemann B, Brix T, et al. Seizure-induced shoulder 
dislocations - Case series and review of the literature. 
Seizure. 2019;70:38-42.
5. Kokkalis ZT, Iliopoulos ID, Antoniou G, Antoniadou 
T, Mavrogenis AF, Panagiotopoulos E. Posterior 
shoulder fracture-dislocation: an update with 
treatment algorithm. Eur J Orthop Surg Traumatol. 
6. Kelly MJ, Holton AE, Cassar-Gheiti AJ, Hanna SA, 
Quinlan JF, Molony DC. The aetiology of posterior 
glenohumeral dislocations and occurrence of  associated injuries: a systematic review. Bone Joint 
J. 2019;101-B(1):15-21.
7. Arora E, Singh H, Gupta YK. Impact of antiepileptic 
drugs on bone health: Need for monitoring, 
treatment, and prevention strategies. J Family Med 
Prim Care. 2016;5(2):248-53.
8. Rocha S, Ferraz R, Prudencio C, Fernandes MH, CostaRodrigues J. Differential effects of antiepileptic 
drugs on human bone cells. J Cell Physiol. 
9. Ibrahima FG, M.L.; Handy Eone, D.; Nana Chunteng, 
T.; Sosso, M.A. Recurrent Bilateral anterior 
Simultaneous Dislocation of The Shoulder Following 
Epileptic Seizures : A Rare Lesional Association. A 
Review. . Int J Ortho Res Ther. 2017;1(1):6-9.
10.Wijers D, Piepers M, Hoogendoorn-Stroband TA, 
Albers R, van der Haven I. Bilateral Posterior Fracture 
Dislocation of the Shoulder Following an Epileptic 
Seizure. MOJ Orthop Rheumatol. 2014;1(2):32-3.
11.Gosens T, Poels PJ, Rondhuis JJ. Posterior dislocation 
fractures of the shoulder in seizure disorders--two 
case reports and a review of literature. Seizure. 
12.von Keudell A, Walley KC, George J, DeAngelis JP, 
Rodriguez EK, Appleton PT. Bilateral posterior 
shoulder fracture dislocations after generalized 
seizure managed with open reduction and internal 
fixation and hemiarthroplasty: a case report. The 
orthopaedic journal at harvard medical school. 
13.Saoussen LS, N.; Anis, H.; Rabiaa, D.; Sana, B.A. 
Bilateral posterior fracture-dislocation of the 
shoulder after epileptic seizures: A case report. 
Junior Medical Research. 2019;2(1):13-7.
14.Murphy JD, Braunlich P, Bansal M.Bilateral Posterior 
Fracture-Dislocation of the Proximal Humerus After 
First-Time Seizure. West Florida Division Virtual 
Research Day. 2020;13.
15.Tellisi NK, Abusitta GR, Fernandes RJ. Bilateral 
posterior fracture dislocation of the shoulders 
following seizure. Saudi Med J. 2004;25(11):1727-9.
16.Rouleau DM, Hebert-Davies J. Incidence of 
associated injury in posterior shoulder dislocation: 
systematic review of the literature. J Orthop Trauma. 
17.McKean AR, Kumar S, McKean GM, Tzias D. Seizureinduced unilateral posterior dislocation of the 
shoulder: a diagnosis not to be missed. Case Reports. 
18.Sanel S, Sencan S, Ocguder A, Solakoglu C. Bilateral, 
locked, recurrent anterior shoulder dislocation: case 
report. Eklem Hastalik Cerrahisi. 2015;26(1):52-5.
19.Siuni EP, M.; Orgiano, F.; Pusceddu, I. Locked posterior 
shoulder dislocations and fracture- dislocations: 
treatment options. J Orthopaed Traumatol. 2011;12.
20.Gurzi MD, De Meo D, Pugliese M, Di Giorgio L, Persiani 
P, Villani C. Bilateral posterior fracture-dislocation 
of the shoulder after epileptic seizure. Trauma Case 
Rep. 2018;13:35-41.
21.Raptis K, Koutserimpas C, Alpantaki K, Kaiafas S, 
Fandridis E, Bourlos D. Neglected Bilateral Anterior 
Shoulder Dislocation Following Epileptic Seizure: A 
Case Report and Literature Review. Kurume Med J. 
22.Abbas A, Navid N, Hanie SS. Bilateral Posterior 
Dislocation of the Shoulder Caused by Seizure after 
Tramadol Usage; A Case Report And Literature 
Review. J Clin Toxicol. 2017;7(357):2161-0495.
23.Torrens C, Santana F, Melendo E, Marlet V, Caceres 
E. Osteochondral autograft and hemiarthroplasty for 
bilateral locked posterior dislocation of the shoulder. 
Am J Orthop (Belle Mead NJ). 2012;41(8):362-4.
24.Betz ME, Traub SJ. Bilateral posterior shoulder 
dislocations following seizure. Intern Emerg Med. 
25.Mc LH. Posterior dislocation of the shoulder. J Bone 
Joint Surg Am. 1952;24 A(3):584-90.
26.Amir MA, Alenazi B, Wyse RK, Tamimi W, Kujan O, 
Khan T, et al. Neglected Bilateral Posterior Shoulder 
Fracture Dislocation in an Uncontrolled Seizure 
patient. Pak J Med Sci. 2015;31(4):1018-20.
27.Konda SR, Fisher N, Gage M, Egol KA. Posterior 
Fracture Dislocation of the Shoulder: A Modified 
McLaughlin Procedure. J Orthop Trauma. 2017;31 
Suppl 3:S36-S7.
28.Everisto O. Posterior Shoulder Fracture Dislocations 
Associated With Seizure Disorders. International 
Journal of Orthopaedics. 2019;6(4):1165-8.
29.Jansen H, Frey SP, Doht S, Meffert RH. Simultaneous 
posterior fracture dislocation of the shoulder 
following epileptic convulsion. J Surg Case Rep. 
30.Rhee P, Main C. Bilateral posterior fracture–
dislocation of the shoulder as a presentation of 
an intracranial tumor. The Internet Journal of 
Orthopedic Surgery. 2006;3.
31.Fan HC, Lee HS, Chang KP, Lee YY, Lai HC, Hung PL, et 
al. The impact of anti-epileptic drugs on growth and 
bone metabolism. International journal of molecular 
sciences. 2016;17(8):1242.
32.Shen C, Chen F, Zhang Y, Guo Y, Ding M. Association 
between use of antiepileptic drugs and fracture 
risk: a systematic review and meta-analysis. Bone. 
33.Miziak B, Chroscinska-Krawczyk M, Czuczwar SJ. An 
update on the problem of osteoporosis in people 
with epilepsy taking antiepileptic drugs. Expert Opin 
Drug Saf. 2019;18(8):679-89.
34.Fraser LA, Burneo JG, Fraser JA. Enzyme-inducing 
antiepileptic drugs and fractures in people with 
epilepsy: A systematic review. Epilepsy Res. 
35.Fu J, Peng L, Li J, Tao T, Chen Y. Effects of SecondGeneration Antiepileptic Drugs Compared to FirstGeneration Antiepileptic Drugs on Bone Metabolism 
in Patients with Epilepsy: A Meta-Analysis. Horm 
Metab Res. 2019;51(8):511-21.
36.Valsamis HA, Arora SK, Labban B, McFarlane SI. 
Antiepileptic drugs and bone metabolism. Nutr 
Metab (Lond). 2006;3:36.
37.Beerhorst K, Tan IY, De Krom M, Verschuure P, 
Aldenkamp AP. Antiepileptic drugs and high prevalence of low bone mineral density in a group of 
inpatients with chronic epilepsy. Acta Neurol Scand. 
38.Gopinath NRP, Prabhakar R,Puneeth K,Sudheer M. 
Neglected Bilateral Anterior Fracture Dislocation 
Shoulder: A Rare Case Report. Journal International 
Medical Sciences Academy. 2016; 29(3):153-154
39.Peshin C, Jangira V, Gupta RK, Jindal R. Neglected 
anterior dislocation of shoulder with large Hillsach’s 
lesion & deficient glenoid: Treated by autogenous 
bone graft & modified Latarjet procedure. J Clin 
Orthop Trauma. 2015;6(4):273-6.
40.Rouhani A, Zonooz KA, Aghdam HA. An unusual cause 
of bilateral anterior shoulder dislocation. Pakistan 
Journal of Medical Sciences. 2010;26(4):976-7.
41.Upasani T, Bhatnagar A, Mehta S. BBilateral 
Neglected Anterior Shoulder Dislocation with 
Greater Tuberosity Fractures. J Orthop Case Rep.