Abstract
[Purpose] We encountered a rare case of glenoid fracture that was considered to be due to dislocation associated epileptic attacks. [Case] A 23-year-old male with pain in the left shoulder. Present illness: He noticed pain and limited motion in the left shoulder when he got up in the morning. Since no improvement was observed after treatment at a local hospital, he visited our department 2 days later. Past history: He developed the first epileptic attack at the age of 5 years. Recently, attacks frequently occurred. Findings at the initial examination: He was 178cm tall and weighed 103kg. The range of motion was markedly limited. Bloody fluid (20ml) was obtained by arthrocentesis. Imaging findings: Plain X-ray examination showed a bone defect in the lower area of the glenoid fossa and slight inferior instability of the humeral head. CT revealed a Hill-Sachs lesion of the humerus on the upper rim of the glenoid fossa and a bone defect involving the anterior 1/3 portion in the lower area of the glenoid fossa. The bone piece was located posterior to the joint, which was confirmed by 3D-CT. Treatment: The bone piece was removed by the posterior approach. Since loaded plain X-ray examination, arthrography, and contrast CT showed the persistence of inferior instability, osteosynthesis was performed using the bone piece that had been frozen and preserved. Discussion: A few patients with shoulder dislocation due to epileptic attacks have been reported, but those in whom dislocation resulted in glenoid fracture have been rarely observed. CT was useful for evaluating fracture in the glenoid fossa and 3D-CT for evaluating the 3D location of the bone piece. When the ratio of the fracture to the articular surface was high, surgery should have been considered.
