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Scapulothoracic dissociation is an infrequent injury with a potentially devastating outcome. The diagnosis is based on clinical and radiographic findings of forequarter disruption. These include massive soft tissue swelling of the shoulder, displacement of the scapula and neurovascular injuries (brachial plexus, subclavian artery and osseous-ligamentous injuries). The mechanism of injury appears to be the delivery of severe rotational force sheering the shoulder girdle from its chest wall attachments around the scapula, shoulder joint and at the clavicle. Early recognition of the entity and aggressive treatment are crucial. Outcome is not dependent on management of the arterial injury, but rather on the severity of the neurological deficit.
KEY WORDS: Scapulothoracic dissociation - Brachial plexus injuries - Subclavian arteries injuries - Wound, non penetrating - Amputation.
Scapulothoracic dissociation (SD) originally described by Oreck et al., is the result of severe blunt trauma or sudden forceful traction applied to the shoulder.1 In definition: subclavian or axillary vascular disruption, lateral displacement of the scapula, separation of the clavicular articulations with or without fracture of the clavicle and cervical nerve roof avulsion or brachial plexus injury. The patient's life is threatened because of concomitant vascular injuries, bone fractures and involvement of the brachial plexus. Formerly, many of these victims died at the scene of the accident, accounting for the small number of cases reported in the literature (to our knowledge less than 72).1-6 Our recent experience with two patients with arterial injury and revascularization in scapulothoracic dissociation is presented.
Case reports
Case 1.-A 20-year-old man was thrown out from a car involved in a head-on collision. On admission to the emergency room he was hemodynamically unstable and in respiratory distress. Systolic blood pressure was 60 mmHg. There were multiple abrasions on the chest wall, massive swelling and ecchymosis of the right shoulder girdle and a huge...