• N Lambrinoudakis, M C Glanzmann, and D Franzen.
• Medizinische Klinik, Spital Zollikerberg, Zollikerberg, Zürich, Schweiz.
• Dtsch. Med. Wochenschr. 2008 Apr 1;133(17):884-6.

HistoryAn 87 year-old woman with insulin dependent diabetes was referred to our hospital because she had sustained a generalized tonic-clonic seizure. Initial blood sugar concentration before hospital admission was 1.1 mmol/l.InvestigationsConventional radiography and computed tomography of both shoulders confirmed the diagnosis of bilateral proximal fractures of the humerus with posterior dislocation. The cause of the seizure was found to be iatrogenic because timing of application of the dual-acting insulin medication had been wrongly changed, and the patient had developed severe hypoglycemia.Treatment And CourseAfter administration of glucose and a 7-day course of antibiotics for aspiration pneumonia, both fractures were treated surgically with hemiarthroplasty. After a four-week stay in hospital the patient was discharged to her nursing home, requiring much more care than before.ConclusionThe presentation of simultaneous bilateral fractures of the humerus is a rare but severe and almost pathognomonic complications of generalized tonic-clonic seizures, for example in the context of marked hypoglycemia. Appropriate monitoring and treatment of blood sugar levels in diabetics must be emphasized.

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