Traumatic Scapulothoracic Dissociation – A Case Report

*Bajracharya S, **Singh M P, ***Singh G K, *Jayaram M, *Shrestha D

* Senior Residents, Department of Orthopedics, BPKIHS, Dharan, India.
** Head and Professor, Department of Orthopedics, BPKIHS, Dharan, India.
*** Professor and Advisor (Indian Advisory Authority), Department of Orthopedics, BPKIHS, Dharan, India.

Address for Correspondence

Dr Suraj Bajracharya,
Department of Orthopedics, BPKIHS, Dharan, India.
E-Mail: drsurajbajra@hotmail.com

J.Orthopaedics 2006;3(2)e10

Introduction :

Scapulothoracic dissociation, as manifested by lateral displacement of the scapula and distracted fracture of clavicle, is a rare injury in which there is a complete disruption of the scapulothoracic articulation without an overlying partial or complete amputation through the soft tissue. Scapulothoracic dissociation may be associated with injuries to the brachial plexus and the subclavian artery and vein; multiple open and closed fractures of the ipsilateral upper extremity are often present.  In the patient with severe multiple injuries, scapulothoracic dissociation may not be recognized immediately, with potentially fatal consequences. In this case report we present a case with clinical and radiographic evidence of scapulothoracic dissociation and review the literature on related injuries 1, 2, 3, 4, 5, 6. In this part of world, this type of injury is rarely noticed and only one reported in Indian Journal of Orthopaedics 7. 

Case Report:

A 19 years boy presented to the Emergency Room with alleged history of a high-speed deceleration motorcycle accident (collision between motorcycle and auto rickshaw). He was thrown from the bike about 2 meters ahead and directly hit on the object on the right shoulder region. At the time of presentation, patient was on hypovolemic shock state for which immediate resuscitation was started. On examination, there was a huge swelling on the anterior, axillary and scapular region of the right shoulder along with bruises over the mid clavicular region; with deformity and swelling of ipsilateral thigh, knee and leg. All the muscles of the shoulder girdle, arm, forearm and hand were paralyzed with complete sensory loss from C5 to T1 dermatome with intact radial and ulnar pulses. On X-ray chest PA view (Fig A & B), there was a distracted fracture of right clavicle and significant lateral displacement of scapula. On CT scan of thoracic inlet, there was displaced and distracted fracture of right clavicle with large hematoma around the anterior, axillary and scapular region of shoulder; with significant collection between the scapula and thoracic wall up to the 7^th, 8^th  ribs. He also had ipsilateral fracture shaft of femur with ipsilateral fracture both bones of leg with lateral tibial plateau fracture. The diagnosis of Blunt traumatic scapulo-thoracic dissociation with lateral scapular displacement with distracted clavicle fracture was made. Conservative treatment was given for the injury around the shoulder whereas closed reduction and internal fixation was done for respective fractures. There was no neurological recovery after 3 months of injury.

Discussion :

Scapulo-thoracic dissociation is an uncommon condition encountered in high-energy trauma and most often relate to motorcycle accidents. They occur as a result of a severe abduction of the upper limb, which induces a lateral displacement of the scapula, a massive disruption of the rotator muscular cuff and an extensive subscapular hematoma. Associated neuro-vascular damage is present in 90% of cases. 

(A)                                                    (B)

Fig: Distracted Right Clavicle with Lateral displacement of scapula

Reference :

1. Oreck-SL; Burgess-A; Levine-AM Traumatic lateral displacement of scapula: a radiographic Sign J-Bone-Joint-Surg-Am. 1984 Jun; 66(5): 758-63

2. Clements RH, Reisser JR. Scapulothoracic dissociation: a devastating injury. J Trauma. 1996 Jan;40(1):146-9.

3. Damschen DD, Cogbill TH, Siegel MJ. Scapulothoracic dissociation caused by blunt trauma. J Trauma. 1997 Mar; 42(3):537-40.

4. Sheafor DH, Mirvis SE Scapulothoracic dissociation: report of five cases and review of the literature. Emerg Radiol 1995 2: 279-284

5. Wintermark M, Schnyder P Trauma of the chest wall. In Schnyder P, Wintermark M. Radiology of blunt trauma of the chest. Springer, Berlin Heidelberg New York 2000, pp 9-27

6. JD Rubenstein, NA Ebraheim and JF Kellam Traumatic scapulothoracic dissociation Radiology 1985, Vol 157, 297-298

7. D.K Patro, S Pai. Traumatic Medial Displacement of Pectoral Girdle (Scapulo- Thoracic Dissociation)-A Case Report, Indian Journal of Orthopaedics October 2000, Vol. 34, No 4, 308-309

This is a peer reviewed paper 

Please cite as : Suraj Bajracharya: Traumatic Scapulothoracic Dissociation – A Case Report

J.Orthopaedics 2006;3(2)e10

URL: http://www.jortho.org/2006/3/2/e10

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