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            [0] => Bilateral combined fracture of the greater tuberosity with anterior internal shoulder dislocation
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            [0] => hopital ibn jazzar
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    [nom] => Array
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            [0] => tounsi
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    [prenom] => Array
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            [0] => abdelkader
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            [0] => drtounsiabdelkader@gmail.com
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Nom prénom / Name Surname: mansi zied
Email: doc.zm@hotmail.fr
Hôpital / Hospital: hopital ibn jazzar kairouan

 
Nom prénom / Name Surname: tounsi abdelkader
Email: drtounsiabdelkader@gmail.com
Hôpital / Hospital: hopital ibn jazzar kairouan

 
Nom prénom / Name Surname: sboui ines
Email: inessboui1234@gmail.com
Hôpital / Hospital: institut kassab tunis

 
Nom prénom / Name Surname: chneti islem
Email: chnetiislem@gmail.com
Hôpital / Hospital: hopital ibn jazzar kairouan

 
Nom prénom / Name Surname: rbai hedi
Email: rbaihedi@gmail.com
Hôpital / Hospital: hopital ibn jazzar kairouan

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            [0] => shoulder-anterior dislocation -bilateral fracture;

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            [0] => 3663
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            [0] => tounsiabdelkaderthese@gmail.com
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    [specialite] => Array
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            [0] => Chirurgie orthopédique et traumatologique
        )

    [pays] => Array
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            [0] => Tunisie
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            [0] => Introduction:
Bilateral combined fracture of the greater tuberosity with anterior internal shoulder dislocation is a rare occurrence, with limited documentation in the literature. While unilateral glenohumeral dislocations with greater tuberosity fractures are estimated at around 7%, bilateral anterior dislocations are even rarer, often linked to specific traumatic events such as convulsive episodes. Urgent therapeutic management is essential, focusing on reducing the dislocation and addressing the associated greater tuberosity fracture. However, there is currently no standardized approach for managing such fractures.
Case Presentation:
A 22-year-old patient presented to the emergency department with closed trauma to both shoulders following a generalized tonic-clonic epileptic seizure. Bilateral anterior shoulder dislocations with fractures of the greater tuberosities were diagnosed. Reduction of the dislocations under general anesthesia was followed by immobilization and further radiological evaluation. Surgical treatment involved greater tuberosity screw fixation, resulting in favorable postoperative outcomes after functional rehabilitation.
Discussion:
The shoulder's extensive range of motion renders it susceptible to instability, making shoulder dislocations relatively common. However, the mechanism of injury in our case, resulting from a convulsive seizure, is atypical for bilateral anterior dislocations. Nerve and vascular complications are potential concerns, warranting thorough examination and appropriate diagnostic imaging.
Prompt reduction of dislocations is crucial, ideally under general anesthesia to prevent iatrogenic injuries. Imaging, including standard radiographs and CT scans, aids in assessing fracture displacement and guiding treatment decisions. Surgical fixation may be necessary for displaced fractures, with various techniques available, though no consensus on superiority exists.
Postoperatively, rehabilitation aims to restore shoulder function and range of motion, with early initiation promoting faster recovery. Functional outcomes are typically assessed using standardized scoring systems, with our patient demonstrating satisfactory results after a 30-month follow-up.
Conclusion:
Bilateral anterior shoulder dislocation with greater tuberosity fractures is exceptionally rare, requiring careful management due to its anatomical and functional significance. Clear therapeutic guidelines are lacking, underscoring the need for further research to establish optimal treatment protocols.
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