A Case Report of Scapulothoracic Dissociation and Literature Review
Keywords:Scapulothoracic Dissociation, digital subtraction angiogram
Background: Scapulothoracic dissociation (STD) is a rare, life-threatening injury, usually resulting from high energy and leading to poor clinical outcomes and high incidence of disability. This case and a review of the literature aimed to highlight the early diagnosis and management of STD.
Case presentation: A 61-year-old man was injured in a motorcycle accident, when he took a sudden turn and fell from his motorcycle. He was admitted to the emergency department of Changsha Central Hospital. Based on the computed tomography (CT) and digital subtraction angiogram (DSA) findings, the patient was diagnosed as follows: right scapulothoracic dislocation syndrome, right subclavian artery rupture, right subclavian vein rupture, right clavicular fracture, right multiple rib fractures, and right lung contusion and laceration. An expanded polytetrafluoroethylene interposition graft was implemented in the right subclavian artery to re-establish continuity of the subclavian artery. Surgery was performed to repair thoracic deformity, and active rehabilitation therapy also was implemented after surgery. The patient was discharged from the hospital and recovered well with grade 4 muscle strength in his right arm.
Conclusions: Physicians should be vigilant for STD in all patients with shoulder girdle injury. DSA could be recommended for patients with unstable hemodynamics. Early diagnostic image tests and individualized management should be implemented, according to the patient’s condition.
Althausen PL, Lee MA, Finkemeier CG. 2003. Scapulothoracic dissociation: diagnosis and treatment. Clin Orthop Relat Res. (416):237-44.
Choo AM, Schottel PC, Burgess AR. 2017. Scapulothoracic Dissociation. Journal of the American Academy of Orthopaedic Surgeons. 25(5):339-47.
Desai S, DuBose J, Parham C, Charlton-Ouw K, Valdes J, Estrera A, et al. 2014. Outcomes after endovascular repair of arterial trauma. Journal of vascular surgery. 60(5):1309-14.
Faulconer ER, Branco BC, Loja MN, Grayson K, Sampson J, Fabian TC, et al. 2018. Use of open and endovascular surgical techniques to manage vascular injuries in the trauma setting: A review of the American Association for the Surgery of Trauma PROspective Observational Vascular Injury Trial registry. J Trauma Acute Care Surg. 84(3):411-7.
Heng K. 2016. "Floating shoulder" injuries. Int J Emerg Med. 9(1):13.
Jordan R, Obmann M, Song B, Nikam S, Mariner D, Toy F, et al. 2019. Hybrid approach to complex vascular injury secondary to blast induced scapulothoracic dissociation. Trauma Case Reports. 23.
Kani KK, Chew FS. 2019. Scapulothoracic dissociation. Br J Radiol. 92(1101):20190090.
Knobloch K, von Falck C, Teebken O, Krettek C. 2006. Scapulothoracic dissociation with subclavian artery dissection following a severe motorbike accident. Eur J Cardiothorac Surg. 30(4):671.
Lee GK, Suh KJ, Choi JA, Oh HY. 2007. A case of scapulothoracic dissociation with brachial plexus injury: magnetic resonance imaging findings. Acta Radiol. 48(9):1020-3.
Lovejoy J, Ganey TM, Ogden JA. 2009. Scapulothoracic dissociation secondary to major shoulder trauma. J Pediatr Orthop B. 18(3):131-4.
Matsagkas M, Kouvelos G, Peroulis M, Xanthopoulos D, Bouris V, Arnaoutoglou E. 2016. Endovascular repair of blunt axillo-subclavian arterial injuries as the first line treatment. Injury. 47(5):1051-6.
Merchant N, Scalea T, Stein D. 2012. Can CT angiography replace conventional bi-planar angiography in the management of severe scapulothoracic dissociation injuries? The American surgeon. 78(8):875-82.
Rankine J. 2004. Adult traumatic brachial plexus injury. Clinical radiology. 59(9):767-74.
Zelle B, Pape H, Gerich T, Garapati R, Ceylan B, Krettek C. 2004. Functional outcome following scapulothoracic dissociation. The Journal of bone and joint surgery. American volume. 86(1):2-8.