244
Injury, 6. 244-245
Fracture due to shock from domestic electricity supply P. H. O’Flanagan Derbyshire
Royal Infirmary,
Derby
Summary
This report describes a fracture-dislocation of the shoulder ioint due to electric shock. This is the first case reported in an English language journal of fracture due to shock from the domestic electricity supply. Other cases have been reported but not caused by such a low voltage current.
CASE
have any burn marks on his hand. His heart rate was 88 per min. and was regular. His right shoulder was X-rayed and showed an incomplete fracture of the surgical neck below the greater tuberosity, a crack fracture of the greater tuberosity, and avulsion of the lesser tuberosity together with a portion of the anterior part of the head of the humerus. There was also a posterior dislocation of the humerus. Fig. 1A shows these features. Fig. 16 shows the shoulder joint after reduction, which was carried out in the fracture clinic.
REPORT
A 68-year-old male presented himself at the Accident and Emergency Department complaining of pain in the right arm. He gave a history of being in the act of unplugging an electric drill from an extension lead when he came into contact with the live terminals. He did not fall or lose consciousness. After a IO-15 second delay his wife disconnected the extension lead. He had enjoyed good health up to this time. On examination he was tender over the upper half of the humerus. Movements of the shoulder were severely restricted. There was no bruising of the arm. The patient had no neurological deficit, nor did he
COMMENT This type of injury has been described in conjuaction with convulsive seizures (Shaw, 1971) muscular violence (Gregerson, 1971), and electric shock (Brinn and Moseley, 1966; DiVincenti, Moncrief, and Pruitt, 1969). In electric shock the factors which determine the effect of the shock are : 1. The type of current. 2. Voltage. 3. Amperage.
A Fig.
I.-A,
Injuries on presentation.
B
8, Shoulder joint after reduction.
O’Flanagan
: Fracture
Due to Electric
245
Shock
4. 5. 6. 7. 8. 9.
Duration of contact. Path taken by the electric current. Resistance of the body. Points of exit and entry. Atmospheric conditions. Factors related to the state of health of the individual (Hesser, Brinn and 1941; Moseley, 1966; DiVincenti and others, 1969). In this case the current is known to be alternating current which is thought to be three to four times as dangerous as direct current (Brinn and Moseley, 1966). The supply was of 240 volts. The duration of contact was approximately 15 seconds. The room where it occurred was dry and warm. The other variables are unknown. The lowest voltage reported in the literature causing unspecified injuries to long bones is 500 volts (DiVincenti and others, 1969). Fractures can be caused by heat (Hesser, 1941; Brinn and Moseley, 1966; DiVincenti and others, 1969), uncoordinated muscle balance (Hesser, 1941), or bya fall at the time of the shock (Hesser, 1941; Brinn and Moseley, 1966; DiVincenti and others, 1969). In this case the patient did not fall. Because he did not have burns on his hands it is assumed that little heat was generated. Presumably the dislocation was produced by the force of the infraspinatus and teres minor muscles along with the deltoid, latissimus dorsi, and teres major muscles, the fractures being caused by the force of these muscles at their insertions on to the tuberosities. Requestsfor
Derby.
reprints shouldbe addressed to:-P.
H. O’Flanagan,
Esq.,
In view of the fact that voltage in this case was so low and that in one reported case (Brinn and Moseley, 1966) a fracture was not diagnosed until l+ years later, it is suggested that X-rays should be taken in cases of electric shock where there is limited limb movement. Acknowledgements I wish to thank Dr. Keith Little for suggesting that I report this case and Mr. J. Collins for his revision of the article. I would also like to thank the Department of Medical Illustration for the photographs.
REFERENCES
BRINN, L. B., and MOSELEY,J. E. (1966), ‘ Bone changes following electrical injury ‘, Am. J. Roentgen., 97, 682. DIVINCENTI, F. C., MONCRIEF,J. A., and PRUITT, B. A., jun. (1969), ‘ Electrical injuries: a review of 65 cases ‘, J. Trauma, 9, 497. GREGERSEN.H. N. (1971). ‘ Fractures of the humerus from mukular violence ‘, Acta orthop. scud, 42, 506. HESSER,F. H. (1941), ‘ A result of contact with a 2400 volt circuit ‘, Bull. Johns Hopkins Hosp., 68, 388. SHAW, J. L. (1971), ‘ Bilateral posterior fracturedislocation of the shoulder and other trauma caused by convulsive seizures ‘, J. Bone Jt Surg., 53A, 1437. M.B.,
B.Ch.,
B.A.O.,
Derbyshire
Royal
Infirmary,
London
Road,
Injury, 6. 244-245
Fracture due to shock from domestic electricity supply P. H. O’Flanagan Derbyshire
Royal Infirmary,
Derby
Summary
This report describes a fracture-dislocation of the shoulder ioint due to electric shock. This is the first case reported in an English language journal of fracture due to shock from the domestic electricity supply. Other cases have been reported but not caused by such a low voltage current.
CASE
have any burn marks on his hand. His heart rate was 88 per min. and was regular. His right shoulder was X-rayed and showed an incomplete fracture of the surgical neck below the greater tuberosity, a crack fracture of the greater tuberosity, and avulsion of the lesser tuberosity together with a portion of the anterior part of the head of the humerus. There was also a posterior dislocation of the humerus. Fig. 1A shows these features. Fig. 16 shows the shoulder joint after reduction, which was carried out in the fracture clinic.
REPORT
A 68-year-old male presented himself at the Accident and Emergency Department complaining of pain in the right arm. He gave a history of being in the act of unplugging an electric drill from an extension lead when he came into contact with the live terminals. He did not fall or lose consciousness. After a IO-15 second delay his wife disconnected the extension lead. He had enjoyed good health up to this time. On examination he was tender over the upper half of the humerus. Movements of the shoulder were severely restricted. There was no bruising of the arm. The patient had no neurological deficit, nor did he
COMMENT This type of injury has been described in conjuaction with convulsive seizures (Shaw, 1971) muscular violence (Gregerson, 1971), and electric shock (Brinn and Moseley, 1966; DiVincenti, Moncrief, and Pruitt, 1969). In electric shock the factors which determine the effect of the shock are : 1. The type of current. 2. Voltage. 3. Amperage.
A Fig.
I.-A,
Injuries on presentation.
B
8, Shoulder joint after reduction.
O’Flanagan
: Fracture
Due to Electric
245
Shock
4. 5. 6. 7. 8. 9.
Duration of contact. Path taken by the electric current. Resistance of the body. Points of exit and entry. Atmospheric conditions. Factors related to the state of health of the individual (Hesser, Brinn and 1941; Moseley, 1966; DiVincenti and others, 1969). In this case the current is known to be alternating current which is thought to be three to four times as dangerous as direct current (Brinn and Moseley, 1966). The supply was of 240 volts. The duration of contact was approximately 15 seconds. The room where it occurred was dry and warm. The other variables are unknown. The lowest voltage reported in the literature causing unspecified injuries to long bones is 500 volts (DiVincenti and others, 1969). Fractures can be caused by heat (Hesser, 1941; Brinn and Moseley, 1966; DiVincenti and others, 1969), uncoordinated muscle balance (Hesser, 1941), or bya fall at the time of the shock (Hesser, 1941; Brinn and Moseley, 1966; DiVincenti and others, 1969). In this case the patient did not fall. Because he did not have burns on his hands it is assumed that little heat was generated. Presumably the dislocation was produced by the force of the infraspinatus and teres minor muscles along with the deltoid, latissimus dorsi, and teres major muscles, the fractures being caused by the force of these muscles at their insertions on to the tuberosities. Requestsfor
Derby.
reprints shouldbe addressed to:-P.
H. O’Flanagan,
Esq.,
In view of the fact that voltage in this case was so low and that in one reported case (Brinn and Moseley, 1966) a fracture was not diagnosed until l+ years later, it is suggested that X-rays should be taken in cases of electric shock where there is limited limb movement. Acknowledgements I wish to thank Dr. Keith Little for suggesting that I report this case and Mr. J. Collins for his revision of the article. I would also like to thank the Department of Medical Illustration for the photographs.
REFERENCES
BRINN, L. B., and MOSELEY,J. E. (1966), ‘ Bone changes following electrical injury ‘, Am. J. Roentgen., 97, 682. DIVINCENTI, F. C., MONCRIEF,J. A., and PRUITT, B. A., jun. (1969), ‘ Electrical injuries: a review of 65 cases ‘, J. Trauma, 9, 497. GREGERSEN.H. N. (1971). ‘ Fractures of the humerus from mukular violence ‘, Acta orthop. scud, 42, 506. HESSER,F. H. (1941), ‘ A result of contact with a 2400 volt circuit ‘, Bull. Johns Hopkins Hosp., 68, 388. SHAW, J. L. (1971), ‘ Bilateral posterior fracturedislocation of the shoulder and other trauma caused by convulsive seizures ‘, J. Bone Jt Surg., 53A, 1437. M.B.,
B.Ch.,
B.A.O.,
Derbyshire
Royal
Infirmary,
London
Road,
