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Yim J, Singleton A, Crist B, Phillips S. Open reduction internal fixation with mesh plating and suture fixation for scapulothoracic dissociation: a case report and discussion of surgical methods. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:403-409. [PMID: 37588490 PMCID: PMC10426545 DOI: 10.1016/j.xrrt.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Jae Yim
- Mercy Health St Vincent Medical Center Department of Orthopedics Toledo, OH, USA
| | - Amy Singleton
- Mercy Health St Vincent Medical Center Department of Orthopedics Toledo, OH, USA
| | - Brett Crist
- Missouri Orthopedic Institute Columbia, MO, USA
| | - Seth Phillips
- Mercy Health St Vincent Medical Center Department of Orthopedics Toledo, OH, USA
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2
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Shih M, Lee KB, Baig MS, Klein A, Rodriguez A, Kirkwood M. Endovascular repair of traumatic axillary artery transection associated with scapulothoracic dissociation complicated by stent separation. J Vasc Surg Cases Innov Tech 2023; 9:101110. [PMID: 36852318 PMCID: PMC9958072 DOI: 10.1016/j.jvscit.2023.101110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/05/2023] [Indexed: 01/25/2023] Open
Abstract
We report the case of a 23-year-old female pedestrian who had been struck by a car and had presented with axillary artery transection in the setting of scapulothoracic dissociation. The initial endovascular repair was compromised by her shoulder instability and had required the addition of bridging stent placement. Caution is advised with endovascular repair in this clinical scenario because of possible stent separation.
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Affiliation(s)
- Michael Shih
- Division of Vascular and Endovascular Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, TX
| | - K Benjamin Lee
- Division of Vascular and Endovascular Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, TX
| | - Mirza S Baig
- Division of Vascular and Endovascular Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, TX
| | - Andrea Klein
- Division of Vascular and Endovascular Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, TX
| | - Alejandra Rodriguez
- Division of Vascular and Endovascular Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, TX
| | - Melissa Kirkwood
- Division of Vascular and Endovascular Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, TX
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3
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Nasir MU, Alsugair F, Sheikh A, Ouellette H, Munk P, Mallinson P. A Comprehensive Radiologic Review of Shoulder Girdle Trauma. Semin Musculoskelet Radiol 2022; 26:527-534. [PMID: 36535588 DOI: 10.1055/s-0042-1755431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Radiologic knowledge of different fracture patterns involving the shoulder girdle is an important tool to generate clinically relevant reports, identify concomitant injuries, guide management decisions, and predict and minimize complications, such as nonunion, osteoarthritis, osteonecrosis, and hardware failure. Complex unstable injuries like scapulothoracic dissociation can also occur because of shoulder girdle trauma. Management options may vary from conservative to surgical, depending on the fracture type and patient factors. Injuries around the shoulder girdle can involve the glenohumeral articulation, scapula, superior shoulder suspensory complex, acromioclavicular joints, and scapulothoracic articulation.
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Affiliation(s)
- Muhammad Umer Nasir
- Department of MSK Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Faisal Alsugair
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Adnan Sheikh
- Department of MSK Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Hugue Ouellette
- Department of MSK Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Peter Munk
- Department of MSK Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Paul Mallinson
- Department of MSK Radiology, Vancouver General Hospital, Vancouver, BC, Canada
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4
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Critical ischemia and myonecrotic sepsis following scapulothoracic dissociation in the setting of apparent hand perfusion: A case report. OTA Int 2019; 2:e048. [PMID: 33937676 PMCID: PMC7997118 DOI: 10.1097/oi9.0000000000000048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/16/2019] [Indexed: 11/25/2022]
Abstract
Scapulothoracic dissociation is a rare and devastating injury to the shoulder girdle. It is often caused by traction or severe blunt trauma injury to the upper extremity and is associated with both neurologic and vascular injuries. Scapulothoracic dissociation is a highly morbid and rare injury pattern that is often seen in conjunction with other traumatic injuries. The authors describe a case of scapulothoracic dissociation with associated complete brachial plexus injury and subclavian artery injury that was complicated by hypoperfusion, myonecrosis, and subsequent polymicrobial infection of the affected limb in the setting of a warm hand with brisk capillary refill. While capillary refill and hand warmth in the setting of a pulseless extremity have been used in previous cases of scapulothoracic dissociation as an indication for limb perfusion and nonoperative management, these markers cannot reliably be used to evaluate collateral circulation as exemplified in this case report. This case highlights multiple important aspects of the evaluation and management of scapulothoracic dissociation that orthopaedic surgeons and vascular surgeons should be familiar with and utilize when dealing with these challenging injuries. Level of Evidence: V
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5
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Jordan R, Obmann M, Song B, Nikam S, Mariner D, Toy F, Lopez R. Hybrid approach to complex vascular injury secondary to blast induced scapulothoracic dissociation. Trauma Case Rep 2019; 23:100236. [PMID: 31453310 PMCID: PMC6702402 DOI: 10.1016/j.tcr.2019.100236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2019] [Indexed: 11/27/2022] Open
Abstract
Scapulothoracic dissociation is a rare but devastating injury complex involving high velocity blunt trauma to the osseous, muscular, neurologic, and vascular structures of the shoulder girdle. Often seen following a motor vehicle or motorcycle accident, this injury complex presents with vascular trauma in over 80% of cases. We present a unique case of scapulothoracic dissociation secondary to a self-inflicted shotgun wound to the shoulder, not previously reported in the literature. The patient presented in hemorrhagic shock, with an open wound to the chest, and a flaccid, pulseless left upper extremity. Imaging was consistent with subclavian artery transection with thrombosis. He underwent successful upper extremity revascularization with a hybrid approach including open wound exploration and endovascular repair of the subclavian artery. Furthermore, we review the diagnosis and treatment of scapulothoracic dissociation and discuss the safety of emerging hybrid vascular techniques in the management of subclavian and axillary vessel trauma.
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Affiliation(s)
- Rebecca Jordan
- Geisinger Wyoming Valley, Department of Trauma Surgery, Department of Vascular Surgery, 1000 E. Mountain Blvd, Wilkes Barre, PA 18711, United States of America
| | - Melissa Obmann
- Geisinger Wyoming Valley, Department of Trauma Surgery, Department of Vascular Surgery, 1000 E. Mountain Blvd, Wilkes Barre, PA 18711, United States of America
| | - Boyoung Song
- Geisinger Wyoming Valley, Department of Trauma Surgery, Department of Vascular Surgery, 1000 E. Mountain Blvd, Wilkes Barre, PA 18711, United States of America
| | - Shivprasad Nikam
- Geisinger Wyoming Valley, Department of Trauma Surgery, Department of Vascular Surgery, 1000 E. Mountain Blvd, Wilkes Barre, PA 18711, United States of America
| | - David Mariner
- Geisinger Wyoming Valley, Department of Trauma Surgery, Department of Vascular Surgery, 1000 E. Mountain Blvd, Wilkes Barre, PA 18711, United States of America
| | - Frederick Toy
- Geisinger Wyoming Valley, Department of Trauma Surgery, Department of Vascular Surgery, 1000 E. Mountain Blvd, Wilkes Barre, PA 18711, United States of America
| | - Richard Lopez
- Geisinger Wyoming Valley, Department of Trauma Surgery, Department of Vascular Surgery, 1000 E. Mountain Blvd, Wilkes Barre, PA 18711, United States of America
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6
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[Neurovascular complications in fractures of the extremities, part 1 : Vascular lesions]. Unfallchirurg 2019; 122:555-572. [PMID: 31270552 DOI: 10.1007/s00113-019-0682-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Neurovascular injuries in fractures threaten at least the function of extremities. The timely interaction between diagnosis and treatment of vascular injuries helps to avoid a poor outcome or even fatal complications. An important parameter is to "think about it" for injuries under strain. An ankle-brachial index (ABI) of <0.9 is an indicator. Massive bleeding, manifest and long-lasting peripheral ischemia and a rapidly expanding hematoma necessitate an immediate surgical intervention. Endovascular techniques are recommended on the extremities of stable patients with circumscribed vascular lesions. The debate about the sequence of repair (vascular vs. osseous) has to be decided on an individual basis; however, when in doubt vascular repair should be given priority. Vessel reconstructions should be performed without tension and must be covered by vital soft tissues, the indications for fasciotomy should be liberally interpreted. The prognosis with respect to preservation of the extremity and long-term functional outcome substantially depends on the quality of treatment of accompanying injuries.
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7
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Beckmann NM, Sanhaji L, Chinapuvvula NR, West OC. Imaging of Traumatic Shoulder Girdle Injuries. Radiol Clin North Am 2019; 57:809-822. [PMID: 31076034 DOI: 10.1016/j.rcl.2019.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Shoulder girdle trauma is one of the most common injuries encountered in emergency centers. These injuries can be easily overlooked due to the complex osteology of the shoulder. Although radiographs are usually sufficient for assessing traumatic shoulder injuries, cross-sectional imaging is sometimes indicated to assess portions of the shoulder not well visualized by radiographs. In this article, the authors review the spectrum of shoulder girdle injuries: sternoclavicular dislocations, clavicle fractures, acromioclavicular separations, shoulder dislocations, scapula fractures, and scapulothoracic dissociation. They also discuss the presentation, imaging evaluation, and classification of these injuries with emphasis on pitfalls in imaging diagnosis and indications for computed tomography/magnetic resonance.
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Affiliation(s)
- Nicholas M Beckmann
- Department of Diagnostic and Interventional Imaging, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, 2.130B, Houston, TX 77030, USA.
| | - Latifa Sanhaji
- Department of Diagnostic and Interventional Imaging, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, 2.130B, Houston, TX 77030, USA
| | - Naga R Chinapuvvula
- Department of Diagnostic and Interventional Imaging, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, 2.130B, Houston, TX 77030, USA
| | - O Clark West
- Department of Diagnostic and Interventional Imaging, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, 2.130B, Houston, TX 77030, USA
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Abstract
Scapulothoracic dissociation is a rare, potentially limb- and life-threatening injury of the shoulder girdle. The injury is characterized by lateral displacement of the scapula resulting from traumatic disruption of the scapulothoracic articulation. The typical physical examination findings consist of substantial swelling of the shoulder girdle, along with weakness, numbness, and pulselessness in the ipsilateral upper extremity. Radiographic evaluation includes measurement of the scapular index on a nonrotated chest radiograph and assessment for either a distracted clavicle fracture or a disrupted acromioclavicular or sternoclavicular joint. Although vascular injury occurs in most patients, emergent surgery is performed only in patients with either limb-threatening ischemia or active arterial hemorrhage. Management of neurologic injury can be delayed if necessary. The location and severity of neurologic injury determine whether observation, nerve grafting, nerve transfer, or above-elbow amputation is performed. Skeletal stabilization procedures include plate fixation of clavicle fractures and reduction of distracted acromioclavicular or sternoclavicular joints. The extent of neurologic injury determines clinical outcomes. Medical Outcomes Study 36-Item Short Form scores are significantly lower in patients with complete brachial plexus avulsion injury than in patients with postganglionic injury.
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9
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Sinha S, Patterson BO, Ma J, Holt PJ, Thompson MM, Carrell T, Tai N, Loosemore TM. Systematic review and meta-analysis of open surgical and endovascular management of thoracic outlet vascular injuries. J Vasc Surg 2013; 57:547-567.e8. [DOI: 10.1016/j.jvs.2012.10.077] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 09/26/2012] [Accepted: 10/04/2012] [Indexed: 10/27/2022]
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10
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Abstract
Scapulothoracic dissociation is rare, resulting from high-energy trauma to the shoulder girdle and disruption of the scapulothoracic articulation. The associated musculoskeletal, vascular, and neurologic injuries carry potentially devastating outcomes. Overall outcomes seem to be closely related to the degree of neurologic impairment sustained. However, given the wide spectrum of injury in scapulothoracic dissociation and limited data concerning outcomes, general recommendations regarding the management of this injury have been difficult to discern. This article reviews the current data regarding the evaluation, diagnosis, treatment, and outcomes after scapulothoracic dissociation.
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11
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Merchant N, Scalea T, Stein D. Can CT Angiography Replace Conventional Bi-Planar Angiography in the Management of Severe Scapulothoracic Dissociation Injuries? Am Surg 2012. [DOI: 10.1177/000313481207800823] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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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Affiliation(s)
| | - Thomas Scalea
- R. Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Maryland
| | - Deborah Stein
- R. Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Maryland
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12
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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.
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13
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Abstract
Fractures of the scapula are rare and the diagnosis and treatment may be unfamiliar to some surgeons. This article outlines a diagnostic work-up and treatment approach for the various types of scapular fractures. The approach helps guide decision making on operative versus nonoperative treatment based on what is known regarding prognosis and outcomes of management. Operative technique and fixation strategies are discussed for the common fracture patterns along with guidelines for postsurgical shoulder rehabilitation.
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Affiliation(s)
- Peter C Lapner
- Division of Orthopedics, University of Ottawa, The Ottawa Hospital, 1648 Critical Care Wing, Box 502, 501 Smyth Road, Ottawa, Ontario, Canada K1H 8L6.
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Scapulothoracic dissociation with acromioclavicular separation: a case report of a novel fixation method. J Orthop Trauma 2008; 22:572-5. [PMID: 18758290 DOI: 10.1097/bot.0b013e3181831352] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We present a case of 39-year-old female with a scapulothoracic dissociation and acromioclavicular (AC) separation and who had fixation of the AC joint with a locking plate, coracoclavicular screw, and transarticular AC screw. The coracoclavicular and AC relationships were maintained during postoperative rehabilitation and after hardware removal. Use of a locking plate can lead to good functional outcome without the complications associated with the use of pin and wire constructs or without violating the subacromial space.
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15
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Newton EJ, Love J. Emergency Department Management of Selected Orthopedic Injuries. Emerg Med Clin North Am 2007; 25:763-93, ix-x. [PMID: 17826217 DOI: 10.1016/j.emc.2007.07.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Rather than providing an encyclopedic review of extremity injuries, this article reviews selected serious injuries of the extremities that can be missed in the emergency department, either because they are relatively uncommon or because they are subtle in their clinical and radiographic presentation. They include injuries to the scapula, the shoulder, the forearm, the femur and hip, the knee, the tibia (which is the most common long bone fracture), and the ankle and foot. Their various causes include sports injuries, falls, and motor vehicle accidents. Several of these injuries can result in emergent complications or have time-dependent outcomes. Consequently, these injuries often must be managed by emergency physicians before specialist expertise becomes available.
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Affiliation(s)
- Edward J Newton
- Department of Emergency Medicine, Keck School of Medicine, LAC+USC Medical Center, Building GNH 1011, 1200 North State Street, Los Angeles, CA 90033, USA.
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Kim JHS, Cancelada D, Meghoo CA. Scapulothoracic dissociation: case report and review of current management. JOURNAL OF SURGICAL EDUCATION 2007; 64:174-7. [PMID: 17574181 DOI: 10.1016/j.jsurg.2006.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2006] [Revised: 12/19/2006] [Accepted: 12/19/2006] [Indexed: 05/15/2023]
Abstract
Scapulothoracic dissociation (SD) was first recognized as a distinct traumatic injury pattern in 1984. This case report and review of the literature will be a comprehensive description of this syndrome and its management. Although the extremity prognosis of this injury is poor, patient outcome can be optimized so that the patient can be returned to the best possible functional status in the most expedient manner.
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Affiliation(s)
- John Hyung-Sun Kim
- Department of Surgery, William Beaumont Army Medical Center, 5005 North Piedras Street, El Paso, TX 79920, USA.
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17
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Brucker PU, Gruen GS, Kaufmann RA. Scapulothoracic dissociation: evaluation and management. Injury 2005; 36:1147-55. [PMID: 16214460 DOI: 10.1016/j.injury.2004.12.053] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2004] [Revised: 11/30/2004] [Accepted: 12/14/2004] [Indexed: 02/02/2023]
Abstract
Scapulothoracic dissociation is an infrequent injury with potentially devastating outcomes. Knowledge of this injury is based on small patient series and case reports. The aim of this article is to review the evaluation, management and functional outcomes following scapulothoracic dissociation. Often caused by high traction forces applied to the shoulder girdle, there is a complete loss of the scapulothoracic articulation with lateral scapular displacement and intact skin. This is frequently associated with muscular, ligamentous and osseous injuries to the shoulder girdle, vascular injuries to the subclavian, or axillary, vessels and brachial plexus lesions. In the acute setting, the timely diagnosis of the associated neurovascular injuries is crucial. Severe neurovascular and soft tissue compromise often requires an early above-elbow amputation. Further, complete brachial plexus avulsions are associated with a limited potential for functional recovery.
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Affiliation(s)
- Peter U Brucker
- University of Pittsburgh School of Medicine, Department of Orthopaedic Surgery, 200 Lothrop Street, PUH C-313, Pittsburgh, PA 15213, USA.
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18
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Zelle BA, Pape HC, Gerich TG, Garapati R, Ceylan B, Krettek C. Functional outcome following scapulothoracic dissociation. J Bone Joint Surg Am 2004; 86:2-8. [PMID: 14711938 DOI: 10.2106/00004623-200401000-00002] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Scapulothoracic dissociation is an infrequent injury that is often accompanied by neurovascular injuries with a potentially devastating outcome. The aim of this study was to evaluate the functional outcome following scapulothoracic dissociation. METHODS During a twenty-four-year period, we treated twenty-five patients with a scapulothoracic dissociation. The average age was 32.5 years. The average Injury Severity Score was 22 points. Nine patients had a complete brachial plexus avulsion, and ten had an incomplete brachial plexus avulsion. Three patients died from their associated injuries, and six patients required an above-the-elbow amputation. The outcome was assessed with use of the Short-Form 36-Item Health Survey, and the shoulder function of the patients who had not had an amputation was evaluated with use of the Subjective Shoulder Rating System. The degree of initial scapular lateralization was quantified with the scapula index. RESULTS The average duration of follow-up was 12.6 years. The physical and mental component summary scores and the scores on the role-physical, general health, vitality, and mental health subscales of the Short-Form 36-Item Health Survey were significantly lower for patients with a complete brachial plexus avulsion (p < 0.05). The Subjective Shoulder Rating System score was also significantly lower in patients with a complete brachial plexus avulsion (33.8 points compared with 72.5 points for the patients with no or an incomplete avulsion, p = 0.046). The average scapula index was 1.29 +/- 0.19. The scores on the Short-Form 36-Item Health Survey scales and the Subjective Shoulder Rating System score did not correlate with the initial scapula index (p > 0.05). CONCLUSIONS The presence of a complete brachial plexus avulsion is predictive of a poor functional outcome in a patient with a scapulothoracic dissociation. Therefore, we suggest a modification of the classification of the severity of this injury, with complete brachial plexus avulsion considered to be the most severe injury type. LEVEL OF EVIDENCE Prognostic study, Level II-1 (retrospective cohort study). See Instructions to Authors for a complete description of levels of evidence.
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Affiliation(s)
- Boris A Zelle
- Investigation Performed at the Department of Trauma Surgery, Hannover Medical School, Hannover, Germany.
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19
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Abstract
Scapulothoracic dissociation is an important and increasingly common clinical condition resulting from massive traction injury to the anterolateral shoulder girdle with disruption of scapulothoracic articulation. It frequently is accompanied by an acromioclavicular separation, displaced clavicular fracture, or sternoclavicular disruption. Vascular lesions have been reported in 88% of patients and severe neurologic injuries occur in 94% of patients. Many patients have a poor outcome with a flail extremity in 52%, early amputation in 21%, and death in 10%. Early recognition of this injury combined with a logical treatment protocol can help to decrease the substantial morbidity and mortality associated with this condition.
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Affiliation(s)
- Peter L Althausen
- University of California, Davis Medical Center, Sacramento, 95817, USA
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20
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Katsamouris AN, Kafetzakis A, Kostas T, Tsetis D, Katonis P. The initial management of scapulothoracic dissociation: a challenging task for the vascular surgeon. Eur J Vasc Endovasc Surg 2002; 24:547-9. [PMID: 12443754 DOI: 10.1053/ejvs.2002.1722] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- A N Katsamouris
- Vascular Surgery, University of Crete Medical School, University Hospital of Herkalion, Crete, Greece.
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21
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Estrada LS, Alonso J, Rue LW. A Continuum between Scapulothoracic Dissociation and Traumatic Forequarter Amputation: A Review of the Literature. Am Surg 2001. [DOI: 10.1177/000313480106700911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Both traumatic forequarter amputation and scapulothoracic dissociation are rare and life-threatening injuries. We present the case of a 31-year old woman who was ejected from a car after a motor vehicle accident and sustained an apparent partial forequarter amputation. Upon examination her injury was found to share many characteristics with a scapulothoracic dissociation injury. With both injuries mortality is high and prompt diagnosis and treatment imperative. By viewing scapulothoracic dissociation and forequarter amputation as a continuum faster recognition and appropriate treatment may be implemented for these devastating injuries.
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Affiliation(s)
- Lance S. Estrada
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jorge Alonso
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Loring W. Rue
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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22
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Masmejean EH, Asfazadourian H, Alnot JY. Brachial plexus injuries in scapulothoracic dissociation. JOURNAL OF HAND SURGERY (EDINBURGH, SCOTLAND) 2000; 25:336-40. [PMID: 11057999 DOI: 10.1054/jhsb.2000.0393] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The rare condition of scapulothoracic dissociation (STD) is characterized by a lateral displacement of the scapula from the thoracic cage following severe trauma to the scapular girdle. This study presents an analysis of five STDs. There were three supraclavicular brachial plexus palsies and two retro- and infraclavicular palsies. Recovery of elbow flexion was obtained in only two cases. Nerve damage dominates the prognosis and nerve recovery only rarely occurs. Nerve surgery should attempt to reestablish elbow flexion.
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Affiliation(s)
- E H Masmejean
- Department of Orthopaedic and Hand Surgery, Hôpital Bichat, Paris, France.
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Abstract
Thoracic trauma is a common cause of significant disability and mortality. Most thoracic injury in developed countries results from motor vehicle crashes (MVC). Imaging of patients with thoracic trauma must be accurate and timely to avoid preventable death. Trauma surgeons prioritize imaging options based on the patient's hemodynamic status, associated injuries, and age. The screening test for the detection of life-threatening thoracic injury is the supine anteroposterior (AP) chest radiograph. Rib fractures are a marker for serious associated injuries, including abdominal injuries. Rib fractures are especially ominous in children and the elderly. Thoracic aortic injury is associated with high-speed mechanisms of injury and can occur in the absence of radiographic signs. Chest computed tomography (CT) can be used as a screening and diagnostic tool for suspected aortic injury. Aortography is reserved for patients with high suspicion of aortic injury or for confirmation of CT scan diagnosis.
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Affiliation(s)
- J C Mayberry
- Department of Surgery, Oregon Health Sciences University, Portland 97201, USA.
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Goldstein LJ, Watson JM. Traumatic scapulothoracic dissociation: case report and literature review. THE JOURNAL OF TRAUMA 2000; 48:533-5. [PMID: 10744299 DOI: 10.1097/00005373-200003000-00029] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- L J Goldstein
- Department of Surgery, University of California, Davis-East Bay, Alameda County Medical Center, Oakland 94602, USA
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26
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Prétre R, Chilcott M, Mürith N, Panos A. Blunt injury to the supra-aortic arteries. Br J Surg 1997. [DOI: 10.1046/j.1365-2168.1997.02756.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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27
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Damschen DD, Cogbill TH, Siegel MJ. Scapulothoracic dissociation caused by blunt trauma. THE JOURNAL OF TRAUMA 1997; 42:537-40. [PMID: 9095124 DOI: 10.1097/00005373-199703000-00024] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Scapulothoracic dissociation is an infrequent injury with a potentially devastating outcome. The diagnosis has heretofore relied on the radiographic description of the forequarter disruption. Recent experience with four patients at a single trauma center, along with review of 54 injuries adequately described in the literature, indicates a broader spectrum of injury. Neurologic injuries occurred in 94% and vascular injuries in 88%. A nearly uniform poor outcome with flail extremity in 52% of patients, early amputation in 21%, and death in 10% reflects the severity of injuries reported. Identification of this injury requires clinical suspicion, based upon the injury mechanism and physical findings, to accurately assess the degree of trauma to musculoskeletal, neurologic, and vascular structures. Based upon these clinical findings, a rational approach to diagnostic techniques, injury classification, and appropriate surgical intervention can be achieved. Outcome is dependent on early recognition of the subset of patients with injuries amenable to surgical treatment and rehabilitation.
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Affiliation(s)
- D D Damschen
- Department of Surgery, Gundersen/Lutheran Medical Center, La Crosse, Wisconsin, USA
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28
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Sheafor DH, Mirvis SE. Scapulothoracic dissociation: Report of five cases and review of the literature. Emerg Radiol 1995. [DOI: 10.1007/bf02615875] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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29
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Fitridge RA, Raptis S, Miller JH, Faris I. Upper extremity arterial injuries: experience at the Royal Adelaide Hospital, 1969 to 1991. J Vasc Surg 1994; 20:941-6. [PMID: 7990189 DOI: 10.1016/0741-5214(94)90231-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE A review of upper extremity arterial injuries managed at the Royal Adelaide Hospital between 1969 and 1991 was undertaken because the optimal management of complex upper extremity trauma, particularly in proximal injuries, remains unclear. METHODS Patients were identified from the computer registry of patients treated by the vascular unit at the Royal Adelaide Hospital. They were studied in three groups: (1) subclavian and axillary artery, (2) brachial artery, and (3) radial and ulnar artery injuries. The mechanism of injury, associated injuries, treatment and outcome were reviewed. RESULTS There were 114 patients with upper extremity arterial injuries: 28 with subclavian and axillary, 62 with brachial, and 24 with radial and ulnar artery injuries. Good upper limb function was obtained in 32% of subclavian and axillary artery injuries, 79% of brachial artery injuries, and all radial and ulnar artery injuries. Amputation was performed in 14% of the proximal injuries and 8% of the brachial artery injuries. Three deaths occurred in this study group. CONCLUSION Blunt proximal injuries were usually associated with neurologic, soft tissue, and bony damage, which was responsible for the poor functional outcome. Critical limb ischemia or severe hemorrhage rarely occurred. Complete brachial plexus lesions resulted in uniformly poor outcomes. More distal injuries were associated with fewer nerve and soft tissue injuries, resulting in a more satisfactory outcome.
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Affiliation(s)
- R A Fitridge
- Department of Vascular Surgery, Royal Adelaide Hospital, Australia
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