SCAPULOTHORACIC DISSOCIATION : A CASE REPORT

Background and Aim : Scapulothoracic dissociation is a rare injury involving separation ofscapula from the thorax along with the upper extremity. Majority of the patients have concomita ntneurovascular injury and the prognosis is uniformly poor in such cases. We present a case ofscapulothoracic dissociation The muscles between the scapula and thorax form Scapulothorac icarticulation. Scapulothoracic dissociation is a devastating injury usually associated withneurovascular injury and a poor prognosis. We report a patient with scapulothoracic dissociationwith scapular fracture and loss of consciousness.Methods : A 39-year-old male patient presented to the emergency department with history of aroad traffic accident with complaints of injury to chest and right shoulder. No emphysema in neck,no midline tenderness and no active bleeding was detected. Respiratory sounds were normal.Abdomen had no tenderness or guarding. The patient was riding a motorbike when a car hit him.On examination, the patient was hemodynamically unstable. There was no extremity deformit ybut there was a massive swelling on right arm. He was on long backboard and had neck collar.Distal pulse on left side was palpable. Right radial pulse was obviously weak. Hip was stable andpassive motions of extremity were normal. Chest radiograph revealed multiple rib fractures. Rightshoulder radiograph revealed fracture of scapula. Brian CT revealed subdural hematoma and scalpfracture. In chest CT mild lung contusion was seen. He was intubated. Vascular surgery consultwas taken then he was moved to neurosurgery service for craniotomy and further treatments. Thepatient was expired.Results : In a patient with the high-energy trauma to upper limb with neurovascular deficit, thediagnosis of scapulothoracic dissociation should be considered as it is usually associated with otherlife threatening injuries.Conclusion : In those patients who require vascular repair, or other surgical interventions in theshoulder region, the brachial plexus should be explored.

Keywords:

scapulothoracic dissociation , scapula fracture , brachial plexus injury , vascular injury