2018 Volume 31 Issue 1 Pages 29-33
A 32-year-old sailor's right arm was caught in a rope and injured. His upper limb became ischemic, and this was complicated by sternoclavicular joint dislocation, scapula fracture, rib fracture, and pneumothorax of the ipsilateral side. Although vein bridging grafting was performed for brachial artery rupture, the brachial artery blood flow was weak. A more proximal artery injury was considered based on ultrasonography. Another end-to-side vein graft was placed for the subclavian artery that had intimal injury, and the blood circulation improved. His upper limb was salvaged without reperfusion toxemia or severe adverse events after the operation, but brachial plexus injury, as well as median nerve rupture and radial and ulnar nerve traction injuries were noted.
Scapulothoracic dissociation is associated with a large spectrum of concomitant injuries, including osseous injury to the shoulder girdle, subclavian vascular injury, brachial plexus injury, muscle injury, and severe soft tissue injury. The diagnosis can be made based on Anterior-Posterior (AP) radiographs demonstrating lateral displacement of the scapula, and multiple vascular injury should be taken into consideration in the presence of injuries such as in the present case.
