Scapulothoracic dissociation is a rare entity that consists of
disruption of the scapulothoracic articulation. The mechanism of injury is
probably traction caused by a blunt force to the shoulder girdle. This
lesion is characterized by massive soft-tissue swelling of the shoulder;
lateral displacement of the scapula, measured radiographically; an injury
to bone (an acromioclavicular separation, a displaced fracture of the
clavicle, or a sternoclavicular disruption); a severe neurovascular injury;
and a variety of upper and lower-extremity fractures. We treated fifteen
patients who had this lesion, most of whom had several associated injuries.
Three patients died: two from exsanguination and one from a cardiac arrest.
In most patients, the damaged artery was repaired and the brachial plexus
was explored. All of the twelve patients who had a complete brachial-plexus
injury were left with a flail upper extremity. Most patients refused
amputation.