Scapulothoracic dissociation : level of vascular insult, an indirect prognostic indicator for the final outcome ?

Published online: Feb 27 2009

Ramesh K. Sen, Ganesh Prasad, Sameer Aggarwal

From the Post Graduate Institute of Medical Education and Research, Chandigarh, India


Scapulothoracic dissociation is the result of severe blunt trauma or sudden forceful traction applied to the shoulder, simulating a traumatic forequarter amputation but with sparing of the skin. This grievous injury results in injury at three levels : neural, vascular and musculoskeletal. Since the neural damage cannot be ascertained in the acute stage of this injury, wheras the vascular injury can be defined, this study aimed to find out any correlation of the eventual neural damage with the level of vascular injury. It became evident, after compilation of the authors' 8 cases and the 37 relevant cases reported in literature, that the patients with subclavian artery injury had more frequently a complete brachial plexus involvement, whereas those with axillary artery involvement sustained more often a partial plexus injury. This correlation was found to be statistically significant (p < 0.05). It is thus concluded that the more proximal the level of vascular injury, the more grave is the neurological damage. This fact can be utilized to prognosticate the eventual outcome of the limb concerned.