Scapulothoracic dissociation with acromioclavicular separation: a case report of a novel fixation method

Endovascular repair of traumatic axillary artery transection associated with scapulothoracic dissociation complicated by stent separation

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.

Scapulothoracic dissociation: a devastating "floating shoulder" injury

Background and aim of the work The term "floating shoulder" was used in a previous paper to describe lesions of at least two components of the SSSC (superior shoulder suspensory complex), a bony-ligamentous structure of the shoulder girdle. Following this article other types of floating shoulder were described, including scapulothoracic dissociation (STD), a rare lesion with potentially devastating consequences, with detachment of the scapular body from the thoracic wall, with following lateralization of the scapula,  fracture of the clavicle or injury of the adiacent sterno-clavear or acromion-clavicular joints. Prognosis and outcome are also negatively influenced by secondary vascular and neurologic injuries.  Methods We review the literature on this lesion and we describe two patients with STD, their treatment and outcome.  Results Reviewing the literature and analysing our cases, we point out that the STD is often associated with serious general lesions and is indicative of an high-energy trauma. The consequences can be disabling for the upper limb (20% amputation, 50% flail limb) or for the general status of the patient (10% mortality).  Conclusions STD must be timely recognized and subsequently properly treated, to avoid the associated general and local injuries (vascular) and subsequently the musculoskeletal lesions.

Scapulothoracic Dissociation: Evaluation and Management

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.

Scapulothoracic dissociation: An emerging high-energy trauma in medical literature

Scapulothoracic dissociation (STD) is a devastating consequence of high-energy trauma sustained by the shoulder girdle that can easily result in rapid mortality. Since described by Oreck et al. in 1984, STD has been reported in a handful of journals and individual case series, though is still considered a rare occurrence in the context of shoulder injuries. In this report, we examine the case of a 25-year-old female involved in a high-speed rollover auto accident. Unique to this case was the discovery of a completely transected axillary artery and vein with intracorporeal bleeding and complete avulsion of the ipsilateral brachial plexus requiring immediate ligation of the vessels followed by interval above-elbow-amputation and later glenohumeral disarticulation.