Up in Arms: Bilateral Luxatio Erecta Fracture-Dislocations
Inferior dislocation (luxatio erecta) is the most uncommon form of dislocation of the glenohumeral joint. The chance that a person endures the specific direction of forces to dislocate both shoulders simultaneously makes bilateral luxatio erecta even more uncommon. In this article, we report the case of a man who sustained bilateral luxatio erecta when he jumped from a falling scaffold and tried grabbing onto another structure.
Discussion
Although inferior shoulder dislocations are rare, they carry a higher rate of complications, most of which our patient experienced. Our patient had bilateral humeral head fractures, which occur in 80% of cases.6 Postreduction CT showed the degree of his fractures (Figure 3).
Our patient also had reduced sensation in the axillary nerve distribution, which occurs in 60% of inferior dislocations.6 Axillary nerve injuries produce numbness in the lateral arm or posterior shoulder and weakness with shoulder flexion, abduction, and external rotation.7 In our patient’s case, sensation returned after reduction, which is typical (most patients have a positive prognosis).8 As the shoulder dislocates inferiorly, the humeral head tears the glenohumeral capsule inferiorly, which can damage the axillary artery. This artery becomes the brachial and eventually the radial and ulnar arteries, which can have decreased or absent pulses with injury.
Inferior dislocations are also associated with abundant soft-tissue injuries, including torn rotator cuff, shoulder capsule avulsion, and disruption of adjacent muscles (supraspinatus, infraspinatus, teres minor, subscapularis, pectoralis major).9Luxatio erecta is relatively easy to diagnose given the unmistakable arm positioning. The key for the physician is first to assess for the many possible complications, then to administer the proper sedation and analgesia for reduction, and finally to reassess for complications.
Am J Orthop. 2016;45(6):E328-E330. Copyright Frontline Medical Communications Inc. 2016. All rights reserved.
