Scapulothoracic Dissociation in a Patient with Polytrauma: a Case Report

Abstract

INTRODUCTION Scapulothoracic dissociation (SD) is a rare but severe injury to the shoulder girdle. It is characterised by complete disruption of the scapulothoracic articulation with lateral scapular displacement and intact skin.1-3 It is a spectrum of musculoskeletal and neurovascular injuries,3 involving high-energy trauma with lateral tractional forces applied to the shoulder girdle.2,4 Scapular Index (SI) is an indicator that is relevant to SD. It is obtained by measuring the distance from the spinous process to the medial border of the scapula, then divide the value of the injured side by the value of the non-injured side. Laterally displaced scapula with SI >1 has been commonly used as a diagnostic criterion for SD in previous studies.5 Nonetheless this requires a nonrotated anteroposterior (AP) chest radiograph that may be impractical in the urgent trauma setting. Moreover, SD may be initially missed in the polytrauma setting with multiple significant injuries.2 Herein, we report a case of SD in a young adult who was involved in a road traffic accident with polytrauma presenting with absent brachial pulse and significant vascular injuries on initial trauma computed tomography (CT) with CT angiogram.