Open Scapulothoracic Dissociation

FISCHER, PHILIP J.; Kent, Raleigh B.

doi:10.1097/00007611-200104000-00005

Cited by 5 publications

(2 citation statements)

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“…For bleeding secondary to the collateral supply, packing of the wound with a return to the operating room in 36 to 48 hours will control the bleeding many times. 32 Also, ligation with a warm ischemia time of less than 6 hours may still allow one to focus on the more threatening injury with an ability to bypass once more stable. If that is not a possibility, then amputation is still a viable option with complete brachial plexus injury.…”

Section: Discussionmentioning

confidence: 99%

Can CT Angiography Replace Conventional Bi-Planar Angiography in the Management of Severe Scapulothoracic Dissociation Injuries?

Merchant

Scalea

Stein

2012

The American Surgeon

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Severe scapulothoracic dissociation (SSTD) (Type III or IV; Zelle classification) is often life-threatening and is commonly associated with other devastating injuries. Rapid evaluation, including of the vascular system, is critical to limit the time to definitive therapy. CT angiography (CTA) has evolved as a diagnostic tool, replacing angiography (angio) as it can simultaneously evaluate bony, soft tissue, and vascular injuries. We hypothesized that CTA would be useful in evaluating patients with SSTD. We retrospectively reviewed the trauma registry between June 2002 and June 2010 to identify patients over 18 years of age who sustained SSTD. Patients that were transferred or died before diagnostic imaging were excluded. Comparisons were made between the group that underwent angio before surgery compared with CTA with regards to outcome and length of hospital and intensive care unit stay. Fourteen patients were identified with Type III or IV SSTD over the study period. In the CTA group, mean Injury Severity Score was higher, but time to definitive operative intervention was significantly shorter. There was no difference in amputation rates or mortality. Replacing arteriography with CTA in the preoperative workup of patients with SSTD reduces time to surgery. Despite a greater injury severity in the group in which CTA was used as the primary imaging modality, length of stay, amputation rates, and mortality were no different. CTA can be safely used to evaluate patients with suspected SSTD.

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Section: Discussionmentioning

confidence: 99%

Can CT Angiography Replace Conventional Bi-Planar Angiography in the Management of Severe Scapulothoracic Dissociation Injuries?

Merchant

Scalea

Stein

2012

The American Surgeon

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“…The majority of injuries are closed. Open injuries as severe as traumatic forequarter amputation may occur [9][10][11]. Anatomic variations of comparable injury severity (closed injuries) are being increasingly recognized [7,[12][13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Scapulothoracic dissociation secondary to major shoulder trauma

Lovejoy

Ganey²,

Ogden³

2009

Journal of Pediatric Orthopaedics B

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Three skeletally immature patients with scapulothoracic dissociation were reviewed. A 5-year-old child's arm, caught in a conveyor belt, led to complete upper extremity amputation. Multiple fractures, muscular damage, and cutaneous and subcutaneous tissue disruption (degloving) were present throughout the avulsed extremity. Replantation was considered, but not carried out because of these extensive injuries. He was treated with a myoelectric prosthesis. Two older boys had scapulothoracic dissociation (one open, one closed) associated with clavicular diaphyseal fractures following blunt trauma. In each case, the clavicle was stabilized, muscular disruptions were reattached, and bleeding was controlled locally, although no specific major vascular repair was required. There was no return of neurologic function, leaving each patient with a flail upper extremity. One patient and his family eventually elected to have a shoulder disarticulation followed by fitting with a myoelectric prosthesis. The other patient still had a flail extremity at his last evaluation 17 months postinjury, but did not return for subsequent evaluation.

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Open scapulothoracic dissociation: a case report and review of literature

Bali

Rangdal

Kumar

et al. 2011

Eur Orthop Traumatol

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Open scapulothoracic dissociation (SD) is a rare injury and an average orthopaedic surgeon might be practically unaware of this entity. To our knowledge, there are hardly any cases of open SD reported in the English literature. We present one such case of open injury associated with total brachial plexus injury, but without any component of vascular injury. The patient was managed by aggressive debridement and fixation of the osseous injury which helped us save the patient from the dreadful complication of sepsis associated with such a severe injury. We briefly review the literature regarding SD and also discuss the management options when encountered with such a severe and rare injury.

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Open Scapulothoracic Dissociation

Cited by 5 publications

References 0 publications

Can CT Angiography Replace Conventional Bi-Planar Angiography in the Management of Severe Scapulothoracic Dissociation Injuries?

Can CT Angiography Replace Conventional Bi-Planar Angiography in the Management of Severe Scapulothoracic Dissociation Injuries?

Scapulothoracic dissociation secondary to major shoulder trauma

Open scapulothoracic dissociation: a case report and review of literature

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