Scapulothoracic Dissociation

Courtesy: Prof Nabil Ebraheim, University of Toledo, Ohio, USA

Education video discussing the condition and treatment of scapulothoracic dissociation.

• Scapulothoracic Dissociation is a rare entity that consists of disruption of the Scapulothoracic articulation.
• It is a traumatic lateral displacement of the scapula with intact skin. It has been described as closed, traumatic for-quarter amputation.
• Closed avulsion of the scapula with associated clavicular fracture, sternoclavicular disruption or acromioclavicular separation.
• Arteriography should be performed to diagnose vascular injury. Reduced pulses or no pulses in the extremity.
• Most often there is varying degrees of injury to the brachial plexus and the subclavian artery resulting in flial, pulseless upper extremity.
• This injury can be missed.
• Chest x-ray shows significant lateral displacement of the scapula. Can be associated with upper extremity fractures such as fractures of the scapula, clavicle and humerus.

Treatment
•Advanced trauma life support-airway, breathing, circulation.
•Angiography and repair of the artery if needed.
•Early above elbow amputation and shoulder fusion based on the degree of neurovascular and scapular muscle damage