Open scapulothoracic dissociation: a case report and review of literature

Abstract

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.

Forequarter amputation for open scapulothoracic dissociation: A case report and surgical technique

“…Majorities of the case reports have described it in terms of intact overlying skin with symptoms like massive swelling, palpable hematoma, gross shoulder subluxation, weakness, and tenderness. Only a handful open SD cases have been reported 3,5 . Here, we present a unique case of open SD with floating shoulder with anterior dissociation resulting from a redundant AC joint, brachial artery injury and complete brachial plexus injury.…”

“…Scapulothoracic dissociation is a devastating injury caused by either a traction force to the upper extremity or massive direct blunt force trauma to the shoulder. It involves musculoskeletal and neurovascular injuries resulting from traumatic disruption of the relationship of the scapula and upper extremity with the thorax 3 . The identification of this condition is often delayed due to the presence of usually multiple other severe distracting injuries 4 …”

“…resulting from traumatic disruption of the relationship of the scapula and upper extremity with the thorax. 3 The identification of this condition is often delayed due to the presence of usually multiple other severe distracting injuries. 4 Oreck et al first described the lateral displacement of the scapula with intact skin as a different variant of traumatic forequarter amputation.…”

“…The typical radiological features of SD include lateral displacement of the scapula along with possible acromioclavicular separation, a displaced clavicular fracture, or sternoclavicular disruption. [3][4][5] There have been very few cases of SD reported in the medical literature. Here, we report a rare case of open SD with surgical technique fore-forequarter amputation and share our insights gained from managing this case.…”

“…SD usually presents as a massive swelling over the shoulder, palpable hematoma, and gross scapular subluxation from thorax in form of lateralization along with signs and symptoms of neurovascular compromise. The typical radiological features of SD include lateral displacement of the scapula along with possible acromioclavicular separation, a displaced clavicular fracture, or sternoclavicular disruption 3–5 …”