ABSTRACTS
Shoulder to Shoulder: Prehospital Bilateral Posterior Shoulder Dislocation on a FarmAuthor: Shane Devlin | | Associate Authors: Ivan O'Grady
Introduction: This case report outlines the management of a rare trauma presentation: simultaneous bilateral posterior shoulder dislocations with a left humeral head fracture in a young man due to a farm accident. Posterior shoulder dislocations account for up to 5% of all dislocations, and 14.6% of these are bilateral in nature, making it a very rare occurrence. Seizures are the most common cause of bilateral dislocations due to violent muscle spasms, pulling the shoulders inwards and posteriorly. Trauma is an infrequent cause, as both arms would likely have to be internally rotated simultaneously on impact to posteriorly dislocate both shoulders. Case Outline: The patient was a 29 year old male, who had fallen onto both his outstretched arms from a tractor bucket, causing bilateral posterior shoulder dislocations. He was found in a prone position in hay and manure. There were no associated injuries and no injuries to the neck or back. Towels and blankets were utilised to make the scene as sterile as possible. Analgesia included Methoxyflurane, Fentanyl, Morphine and Ketamine. The vacuum mattress was used to immobilise both shoulders. Slow and easy transport to a trauma centre was employed to reduce any excessive movement en route. Conclusions: At the time of writing, there are no documented prehospital cases in the literature and hence no best practice advice for managing these patients. This case report outlines the prehospital management for this particular patient presentation, and opens the floor for further discussion and research on the topic.
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