Functional Outcome Following Scapulothoracic Dissociation

Brachial Plexus Injury: Long-Term Functional Outcome is Determined by Associated Scapulothoracic Dissociation

“…20 Active hemorrhage prompted surgical intervention in half of our patients with arterial disruption. Two patients did not require surgery for occlusive vascular injuries from intimal or medial disruption.…”

“…Moreover, in a study of 25 patients with SD, Zelle et al found that all patients with complete brachial plexus avulsions had a flail extremity at a mean of 12.6 years after injury. 20 In their outcome study of SD patients, patients with partial BPI scored significantly better on the SF-36 and the Subjective Shoulder Rating Scale. We elected not to use the entire SF-36 scale in favor of a shorter questionnaire designed for telephone response, which focused on comprehensive evaluation of shoulder, elbow, wrist, and hand function and included only the most pertinent questions about quality of life in general.…”

“…25,26 Amputation rates for patients with SD range from 21% to 24%. 20,21 Our amputation rate of 9% is likely to be lower because of an aggressive approach to timely vascular repairs and late orthopedic reconstruction. Early amputation is indicated in patients who have complete brachial plexus disruption found during exploration of vascular and orthopedic injuries.…”

Open scapulothoracic dissociation: a case report and review of literature

“…Majority of authors have recommended an early aboveelbow amputation for complete brachial plexus avulsions, since there is limited potential for functional recovery and the result is usually a flail, functionless upper extremity [7,10,11]. Boris et al [2], in their series of 25 patients, concluded that the long-term outcome following a SD depends primarily on the degree of neurological injury. Sen et al [1] further correlated the severity of neurological deficit and the final functional outcome with the level of vascular insult.…”

“…Motorcycle accidents, directly acting traction force on upper extremity (as in industrial mishaps) and fall from height are the commonly observed modes of injury in association with SD [1,2]. SD presents with diverse combination of injuries to its components involving osseoligamentous structures around shoulder girdle, subclavian or axillary artery injury and the brachial plexus.…”