Scapulothoracic dissociation secondary to major shoulder trauma

Abstract

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.

A Case Report of Scapulothoracic Dissociation and Literature Review

“…A retrospective research with 25 STD patients indicated that more than half occurred as a result of a motorcycle accident [Zelle 2004], as well as in our case. Although most patients were adults, a few immature patients with STD also recently have been reported [Lovejoy 2009].…”

Neurovascular Injury Following Traumatic Posterior Shoulder Dislocation in an Adolescent Contact Athlete

“…Combined injuries to neurovascular structures around the shoulder typically result from high-energy trauma as seen in scapulothoracic dissociation (SD), which is characterized as a complete disruption of the scapulothoracic articulation with lateral scapular displacement and intact skin leading to a spectrum of musculoskeletal, neurologic, and vascular injuries 10,23 . SD is a rare traumatic injury most commonly found in adults, with only a few reports in the pediatric age group [24][25][26][27] . In the case reported here, our initial clinical impression was that the patient experienced a subtype of SD, as suggested radiographically by the combined neurovascular injury and laterally displaced scapula.…”