The neurovascular outcome of scapulothoracic dissociation

The purpose of this study was to define the role of acute revascularization in the management of scapulothoracic dissociation (SD), a rare injury of the upper extremity in which severe traction to the shoulder girdle results in combined arterial, brachial plexus, and musculoskeletal injury.

The results of a retrospective study of 11 patients with SD who were compared with 41 patients from the literature are presented.

All 11 patients were involved in high-speed accidents. All patients had chest wall hematoma, absent radial pulse, and complete brachial plexus palsy. All patients had subclavian or axillary occlusion shown by angiography; one patient with simultaneous brachial artery injury had limb-threatening ischemia. No patient had active bleeding from the injured artery. Six limbs were revascularized, five were not. All five non-revascularized limbs remained viable. No patient had delayed hemorrhage. No patient had significant neurologic recovery; all limbs remained insensate and functionless. Two viable arms underwent late amputation because of neurologic dysfunction.

The infrequent occurrence of delayed hemorrhage and limb-threatening ischemia and the dismal functional outcome of the brachial plexus injury suggest a conservative policy toward revascularization for the arterial injury in SD.