A Devastating Shoulder Girdle Injury and an Innovative Approach to Management - A Case Report
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S K Srinivasa Ram Prakassh1, Mohamed Sameer1, Srijay Sashaank1
1Department of Orthopaedics, Sri Ramachandra Institute of Health Education and Research, Chennai, Tamil Nadu, India.
Introduction:
Scapulothoracic dissociation is a rare, potentially devastating high-energy injury of the shoulder girdle, frequently associated with neurovascular and musculoskeletal injuries. While management primarily focuses on life- and limb-threatening complications, the role of operative skeletal stabilization remains less clearly defined. We present a case of Type I scapulothoracic dissociation with an unstable bifocal disruption of the superior shoulder suspensory complex (SSSC) managed using a customized fixation construct.
Case Report:
A 35-year-old male sustained a Type I scapulothoracic dissociation following a high-energy motor vehicle collision, associated with a scapular spine-acromion fracture and acromioclavicular joint disruption resulting in an unstable bifocal SSSC injury. Following initial stabilization, operative fixation was performed using a customized contoured infrapectineal plate spanning the scapular spine, acromion, and clavicle, supplemented with coracoclavicular fixation. At 12-month follow-up, the patient achieved satisfactory functional recovery with 120° abduction and 150° forward flexion, without scapulothoracic instability or implant failure.
Conclusion:
Operative stabilization of scapulothoracic dissociation associated with an unstable bifocal SSSC injury can restore shoulder-girdle stability and facilitate functional recovery. In selected patients, a customized fixation construct may provide a viable solution when conventional fixation strategies are inadequate for the complex injury pattern.
