Abstract：
UNASSIGNED: Bilateral combined fractures of the greater tuberosity with anterior internal shoulder dislocation are extremely rare, presenting challenges in treatment due to their uncommon occurrence and lack of standardized management protocols.
METHODS: We report the case of a 22-year-old patient who experienced bilateral anterior shoulder dislocations with associated fractures of the greater tuberosities following a seizure-induced fall. Clinical Discussion: The unique aspect of our case is the unusual mechanism of injury. Unlike typical convulsive seizures, which often result in bilateral posterior dislocations, our patient suffered bilateral anterior dislocations and fractures of the greater tuberosities. Therapeutic management of greater tuberosity fractures lacks a standardized approach, but surgical intervention is warranted if displacement exceeds 0.5 cm. Treatment options include open reduction and internal fixation (ORIF), percutaneous screw fixation, arthroscopic procedures with suture anchors for double-row repair, or a combination of arthroscopic techniques and screw fixation. ORIF with plate osteosynthesis may be recommended for comminuted fractures with large fragments. To assess functional outcomes, commonly used scoring systems include the UCLA Shoulder Score, ASES Score, and Constant-Murley Score.
CONCLUSIONS: Bilateral anterior shoulder dislocation associated with combined fractures of the greater tuberosity is an extremely rare occurrence. Given its anatomopathological significance and impact on functional recovery, careful and individualized management of greater tuberosity fractures is crucial, considering its role as a point of insertion for the rotator cuff tendons.
METHODS: We report the case of a 22-year-old patient who experienced bilateral anterior shoulder dislocations with associated fractures of the greater tuberosities following a seizure-induced fall. Clinical Discussion: The unique aspect of our case is the unusual mechanism of injury. Unlike typical convulsive seizures, which often result in bilateral posterior dislocations, our patient suffered bilateral anterior dislocations and fractures of the greater tuberosities. Therapeutic management of greater tuberosity fractures lacks a standardized approach, but surgical intervention is warranted if displacement exceeds 0.5 cm. Treatment options include open reduction and internal fixation (ORIF), percutaneous screw fixation, arthroscopic procedures with suture anchors for double-row repair, or a combination of arthroscopic techniques and screw fixation. ORIF with plate osteosynthesis may be recommended for comminuted fractures with large fragments. To assess functional outcomes, commonly used scoring systems include the UCLA Shoulder Score, ASES Score, and Constant-Murley Score.
CONCLUSIONS: Bilateral anterior shoulder dislocation associated with combined fractures of the greater tuberosity is an extremely rare occurrence. Given its anatomopathological significance and impact on functional recovery, careful and individualized management of greater tuberosity fractures is crucial, considering its role as a point of insertion for the rotator cuff tendons.
摘要：
■双侧大结节合并肩关节前内脱位的骨折极为罕见，由于其罕见的发生和缺乏标准化的管理方案，在治疗中提出了挑战。
方法：我们报告了一例22岁的患者，该患者在癫痫发作后出现双侧前肩关节脱位并伴有大结节骨折。临床讨论：我们病例的独特之处在于异常的损伤机制。与典型的惊厥性癫痫发作不同,这通常会导致双侧后脱位，我们的患者患有双侧前脱位和大结节骨折。大结节骨折的治疗管理缺乏标准化的方法，但如果位移超过0.5厘米，手术干预是必要的。治疗方案包括切开复位内固定(ORIF),经皮螺钉固定,用缝合锚进行双排修复的关节镜手术，或关节镜技术和螺钉固定的组合。对于碎片较大的粉碎性骨折，建议使用ORIF与钢板接骨术。为了评估功能结果，常用的评分系统包括加州大学洛杉矶分校肩部评分，ASES评分,和Constant-MurleyScore.
结论：双侧肩关节前脱位合并大结节骨折的发生率极为罕见。鉴于其解剖病理学意义和对功能恢复的影响，仔细和个性化的治疗大结节骨折是至关重要的，考虑到它作为肩袖肌腱插入点的作用。
方法：我们报告了一例22岁的患者，该患者在癫痫发作后出现双侧前肩关节脱位并伴有大结节骨折。临床讨论：我们病例的独特之处在于异常的损伤机制。与典型的惊厥性癫痫发作不同,这通常会导致双侧后脱位，我们的患者患有双侧前脱位和大结节骨折。大结节骨折的治疗管理缺乏标准化的方法，但如果位移超过0.5厘米，手术干预是必要的。治疗方案包括切开复位内固定(ORIF),经皮螺钉固定,用缝合锚进行双排修复的关节镜手术，或关节镜技术和螺钉固定的组合。对于碎片较大的粉碎性骨折，建议使用ORIF与钢板接骨术。为了评估功能结果，常用的评分系统包括加州大学洛杉矶分校肩部评分，ASES评分,和Constant-MurleyScore.
结论：双侧肩关节前脱位合并大结节骨折的发生率极为罕见。鉴于其解剖病理学意义和对功能恢复的影响，仔细和个性化的治疗大结节骨折是至关重要的，考虑到它作为肩袖肌腱插入点的作用。
