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

Document Type : SYSTEMATIC REVIEW

Authors

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

Abstract

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

Keywords


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. 
2017;27(3):285-94.
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. 
2019;234(11):19691-701.
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. 
2000;9(6):446-8.
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. 
2016;17:88-92.
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. 
2012;26(4):246-51.
17.McKean AR, Kumar S, McKean GM, Tzias D. Seizureinduced unilateral posterior dislocation of the 
shoulder: a diagnosis not to be missed. Case Reports. 
2018;2018.
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. 
2020;66(1):65-70.
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. 
2007;2(1):63-5.
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. 
2012;2012(11).
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. 
2014;64:246-53.
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. 
2015;116:59-66.
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. 
2013;128(4):273-80.
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. 
2016;6(2):53-6