Abstract
Scapulothoracic dissociation (STD) is the result of a severe blunt injury to the shoulder girdle, the force being applied to the anterolateral portion of the shoulder. STD is characterized by a lateral displacement of the scapula from the thoracic cage with a poor prognosis. This study presents an analysis of 7 STDs associated with neurovascular injuries that treated from 1990 to 2003. All were males with an average age of 33.1 years (range 17 to 64 years). The average follow-up period was 2.1 years (range 1.6 to 3 years). All patients had brachial plexus injury and subclavian or axillary artery injury and multiple open and closed fractures of the ipsilateral upper extremity. Four patients underwent repair of the damaged artery using vein graft. Intercostal nerve transfer for the brachial plexus paralysis was done in 5 patients. Only 1 patient (aged 64 years) in this series required disarticulation of the shoulder on the second day of the hospital stay due to inadequate vascular function. Primary amputation should be not considered in patients with adequate vascular function from collateral circulation. The decision of the initial management of patients with STD is difficult. The ultimate goal is to seek the best possible functional outcome in each patient.
