Anterior Shoulder Fracture Dislocation in A Patient With Stiffmans Syndrome and Convulsive Disorder: Rare Case Report

Opondo Everisto1, MbChb, Mmed, FCS (Cosecsa), PhD

1 Senior lecturer and Consultant Orthopaedic Surgeon, Department of Surgery, Jomo Kenyatta University of Agriculture and Technology.

Conflict-of-interest statement: The author(s) declare(s) that there is no conflict of interest regarding the publication of this paper.

Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http: //creativecommons.org/licenses/by-nc/4.0/

Correspondence to: Dr. Opondo Everisto, Department of Surgery, Jomo Kenyatta University of Agriculture and Technology, P.o Box 105, 002, 02, Nairobi, Kenya.
Email: opondodr@gmail.com
Telephone: +254 722475767

Received: June 23, 2019
Revised: July 10, 2019
Accepted: July 17 2019
Published online: August 31, 2019


Anterior shoulder fracture dislocation is a challenging case though commonly seen in conjunction with convulsive disorders. No case of stiff-Person Syndrome (SPS) presenting with anterior fracture dislocation is reported in the literature. SPS is estimated to have a prevalence of about one per million with the first known description being attributed to Moersch and Woltman in 1956. The diagnosis and injury patterns of anterior fracture dislocation are more clearly seen on Computed Tomography (CT) Scans which also aids in planning for the surgical management. The treatment outcome after surgical reduction and internal fixation of the fracture with dislocation is associated with excellent functional results.

Key words: Anterior; Fracture dislocation; Stifman syndrome

© 2019 The Author(s). Published by ACT Publishing Group Ltd. All rights reserved.

Everisto O. Anterior Shoulder Fracture Dislocation in A Patient With Stiffmans Syndrome and Convulsive Disorder: Rare Case ReportInternational Journal of Orthopaedics 2019; 6(4): 1169-1171 Available from: URL: http://www.ghrnet.org/index.php/ijo/article/view/2675


Anterior dislocation of the shoulder in a patient with stiffmans syndrome is not reported anywhere in the litrature. This kind of injury usually occurs as a result of a major trauma[1]. These injuries often occur as a result of high energy trauma and accidents. The literature review showed few cases with no adequate follow up results. Isolated fractures of the greater tuberosity constitute 17% to 21% of proximal humeral fractures, and approximately 15% to 30% of them are associated with a traumatic anterior dislocation of the shoulder[2,3]. Nonoperative treatment for nondisplaced fractures after reducing the dislocation is suggested , but there is no consensus on the degree of displacement that warrants surgery[3].

Here we report a case of 33 year old man with anterior dislocation due to trivial trauma.


A 33 year old was brought into the emergency department after having had a seizure while asleep. According to the sister he fell off bed while asleep. The past medical history revealed Stiffmans Syndrome on follow up by a neurophysician for 3 years. The patient was orientated normally on arrival but he could not remember clearly the incident. He denied any history of alcohol consumption or pior seizure disorder. Cardiovascular examination was normal. On physical examination an impression of anterior dislocation of the humerus head was made.This was confirmed by plain radiographs and CT scan of the shoulder (Figures 1, 2 and 3).

On X-ray the head of the humerus was not only dislocated anteriorly, but also fractured into 2 parts (Figuers 4 and 5). A cerebral CT scan was normal. An Elecroencephalogram showed an normal pattern with much slow activity in the left temporal region, with some isolated sharp waves, but no clear epileptic activity. The patient was managed by open reduction and internal fixation using two 3.5 mm half threaded screws after reduction of the fracture. Post operatively the patient was started on physiotherapy after two weeks and regained full range of motion by the third month post surgery.

Figure 1 AP X ray showing anterior fracture dislocation.

Figure 2 CT Scan showing anterior fracture dislocation.

Figure 3 Pre operative CT Scan showing fracture dislocation.

Figure 4 Immediate post operative X rays showing fixed fracture fragment and reduced dislocation.

Figure 5 Post operative X-ray at 3 months.


The anterior dislocation of the shoulder and fracture of humerus are commonly encountered problems but simultaneous occurrence of them is extremely rare. Most of the reports in the literature are restricted to case reports only by various authors[4,5,6,7]. Flint reported dislocation of the shoulder with three parts proximal humerus fracture and shaft of humerus fracture[8,9].

Most injuries reported in the literature are caused by high velocity accidents due to motorcycle and car accidents. The orther reported mechanism of injury is falls from heights. Its postulated that these injuries occur due to a flexed elbow with slight abduction of the shoulder. The mechanism of a greater tuberosity fracture is usually described as an avulsion fracture of the rotator cuff that occurs as a shearing against the glenoid rim in extreme rotation, which then hits the greater tuberosity as it moves towards the acromion[10,11,12]. Whether the dislocation and fracture occur simultaneously or subsequently is controversial a subject of biomechanical studies. Some studies have proposed that with injuries involving high velocity trauma, the axial loading force leads to the transfer of energy to the shaft of the humerus and into the shoulder, resulting in the simultaneous injuries[9,10].

Conservative managed for the cases of dislocation with fracture is reported with good outcomes. However in case of failed closed reduction open reduction and internal fixation is recommended to avoid further iatrogenic injuries. Post-operatively the patient recovered uneventfully. Anatomic reconstruction of the greater tuberosity and subsequent rotator cuff repair allow for early passive motion of the joint; the subsequent avoidance of tendon retraction, malunion, and secondary displacement yields a predictable and satisfactory clinical outcome.


Anterior fracture dislocation of the humerus is rare and a challenging task. It wasnt possible to treat this patient by closed reduction because the dislocation was locked. Three months after operation the result was satisfactory and long term follow up is needed to rule out possible complications.

Ethical stanadrds

The patient gave the informed consent to the publication of the case study. There is no conflict of interest.


1. Ahmad R, Ahmed S, Bould M. Iatrogenic fracture of humerus- complication of a diagnostic error in a shoulder dislocation: a case report. J Med Case Reports. 2007; 1: 41.

2. Rowe CR. Prognosis in dislocations of the shoulder. J Bone Joint Surg Am. 1956; 38: 957-977. [PMID: 13367074]

3. Lind T, Kroner K, Jensen J. The epidemiology of fractures of the proximal humerus. Arch Orthop Trauma Surg. 1989; 108: 285-287. [PMID: 2789504]

4. Platzer P, Kutscha Lissberg F, Lehr S, et al. The influence of displacement on shoulder function in patients with minimally displaced fractures of the greater tuberosity. Injury. 2005; 36: 1185-1189. [PMID: 15963996]; [DOI: 10.1016/j.injury.2005.02.018]

5. Karimi Nasab MH, Shayesteh Azar M, Sajjadi Saravi M, Daneshpoor SMM. Anterior Shoulder Dislocation and Ipsilateral Humeral Shaft Fracture. Iran J Med Sci. 2012; 37(3): 202-204. [PMID: 23115454]; [PMCID: PMC3470086]

6. Sasashige Y, Kurata T, Masuda Y, ShimonoK, Nagata Y. Dislocation of the shoulderjoint with ipsilateral humeral shaft fracture: two case reports. Arch Orthop Trauma Surg. 2006; 126: 562-7.

7. Chen CH, Lai PL, Niu CC, Chen WJ, Shih CH. Simultaneous anterior dislocation of shoulder and fracture of the ipsilateral humeral shaft. In Orthop. 1998; 22: 65- 7. [PMID: 9549586]; [PMCID: PMC3619649]; [DOI: 10.1007/s002640050211]

8. Pradhan I, Banskota AK. Anterior dislocation of the shoulder with ipsilateral humerus shaft fracture. Kathmandu University Med J 2008; 6: 502-504. [PMID: 19483433]

9. Flint JH, Carlyle LM, Christiansen CC, Nepola JV. Case report and literature review anterior shoulder dislocation with three-part proximal humerus fracture and humeral shaft fracture. Iowa Orthop J. 2009; 29: 105-13. [PMID: 19742096]; [PMCID: PMC2723703]

10. Barquet A, Schimchak M, Carreras O, LeonH, Masliah R. Dislocation of the shoulder with fracture of the ipsilateral shaft of the humerus. Injury 1985; 16: 300-2. [PMID: 4008003]; [DOI: 10.1016/0020-1383(85)90128-7]

11. Bahrs C, Lingenfelter E, Fisher F, Walters EM, Schnabel M. Mechanism and Morphology of the greater tuberosity fragment. J Soulder Elbow Surg. 2006; 15: 140-147.[PMID: 16517355]; [DOI: 10.1016/j.jse.2005.07.004]

12. Olivier H, Duparc J, Romain F. Fractures of the greater tuberosity of the humerus. Orthop Trans. 1986; 10: 223.


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