The neurovascular outcome of scapulothoracic dissociation

Sampson, Lawrence N.; Britton, John C.; Eldrup-Jørgensen, Jens; Clark, David E.; Rosenberg, Joel; Bredenberg, Carl E.

doi:10.1016/0741-5214(93)90679-g

Cited by 63 publications

(21 citation statements)

References 21 publications

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“…Another unusual presentation of this case is the absence of vascular deficit which is contradictory to the observations of most of the authors [5,6]. Most of the previous studies [5,6] have reported a relative higher frequency of isolated blunt arterial injuries as compared to that of isolated neurological injuries. This might partly be explained by the tendency of vascular structures to give way before the nerves [6].…”

Section: Discussioncontrasting

confidence: 72%

“…This pattern of wound is very much similar to the only other such case reported by Fischer et al [3]. Another unusual presentation of this case is the absence of vascular deficit which is contradictory to the observations of most of the authors [5,6]. Most of the previous studies [5,6] have reported a relative higher frequency of isolated blunt arterial injuries as compared to that of isolated neurological injuries.…”

Section: Discussionsupporting

confidence: 58%

“…Damschen et al [7] recommend a vascular repair within 4-6 h after injury. On the other hand, Sampson et al [5] suggest a non-operative approach for haemodynamically stable patients with vascular injuries. This recommendation is based on the fact that arterial occlusion rarely results in limb-threatening ischaemia due to the presence of extensive collateral network around the shoulder.…”

Section: Discussionmentioning

confidence: 98%

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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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Section: Discussioncontrasting

confidence: 72%

Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 98%

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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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“…Scapular fractures have been associated with rib and clavicular fractures, pleuro-pulmonary lesions, extremity fractures, cervical sprains, and craniocerebral trauma [4,21,27]. The same associations are noted in publications on scapulothoracic (ST) dislocations [3,6,9,16,19,23]. These studies note that an associated fracture of the ipsilateral clavicle and/or rib occurs between 20 and 51% of the time (Table 2).…”

Section: Discussionmentioning

confidence: 53%

The lateral impaction of the shoulder

Scarlat¹,

Cuny²,

Goldberg

et al. 1999

International Orthopaedics

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17 patients had radiographic demonstration of injury to the clavicle, scapula and ribs from an impact delivered to the lateral shoulder. The study included 13 males and 4 females whose ages ranged from 18 to 83 years (average 45 years). Most injuries were sustained in falls or motor vehicle accidents. Analysis of these cases suggests a biomechanical hypothesis concerning the transmission of the impact forces within the shoulder girdle. According to this hypothesis, the impaction force applied to the lateral shoulder is transmitted from outside inward following two paths. The anterior and superior path passes through the acromio-clavicular joint, the clavicle, the costo-clavicular joint and the sterno-clavicular joint. The posterior and inferior path is transmitted within the gleno-humeral joint, the scapula and the scapulo-thoracic joint. Major impacting force is required to disrupt the anterior and posterior arches of the shoulder girdle. When both of these supporting structures are damaged, the patient is at risk for more serious injuries, including disruption of the thorax, shoulder joint, brachial plexus and neck.Résumé Les auteurs communiquent l'observation des caractéristiques communes pour 17 cas de traumatismes complexes de l'épaule, associant comme lésions des fractures de la clavicule de l'omoplate et des côtes. L'analyse des cas suggère une hypothèse biomécanique concernant la transmission des forces d'impaction traumatique au niveau de la ceinture scapulaire. Conformément a cette hypothèse, la force traumatique appliqué sur la face externe de l'épaule est transmise de l'extérieur vers l'intérieur sur deux voies vectorielles. La voie antéro-supérieure passe par l'articulation acromio-claviculaire, la clavicule, l'articulation costo-claviculaire et l'articulation sterno-claviculaire. La voie postéro-inférieure passe par l'articulation gléno-humérale, l'omoplate et le complexe scapulo-thoracique. Théoriquement, les lésions peuvent se produire sur tout point du trajet vectoriel. En particulier, les lésions peuvent se manifester au niveau de l'arche antérieure ou postérieure du cintre omocle-thoracique, en extérieur et a l'intérieur du cintre.

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“…The clinical outcome after scapulothoracic dissociation is almost uniformly poor. In a review of 11 patients with scapulothoracic dissociation, Sampson et al [22] showed that no patient had enough neurologic function to make the arm useful.…”

Section: Discussionmentioning

confidence: 98%

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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The neurovascular outcome of scapulothoracic dissociation

Cited by 63 publications

References 21 publications

Open scapulothoracic dissociation: a case report and review of literature

Open scapulothoracic dissociation: a case report and review of literature

The lateral impaction of the shoulder

Scapulothoracic dissociation secondary to major shoulder trauma

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