Scapulothoracic dissociation caused by blunt trauma.

Scapulothoracic dissociation is an infrequent injury with a potentially devastating outcome. The diagnosis has heretofore relied on the radiographic description of the forequarter disruption. Recent experience with four patients at a single trauma center, along with review of 54 injuries adequately described in the literature, indicates a broader spectrum of injury. Neurologic injuries occurred in 94% and vascular injuries in 88%. A nearly uniform poor outcome with flail extremity in 52% of patients, early amputation in 21%, and death in 10% reflects the severity of injuries reported. Identification of this injury requires clinical suspicion, based upon the injury mechanism and physical findings, to accurately assess the degree of trauma to musculoskeletal, neurologic, and vascular structures. Based upon these clinical findings, a rational approach to diagnostic techniques, injury classification, and appropriate surgical intervention can be achieved. Outcome is dependent on early recognition of the subset of patients with injuries amenable to surgical treatment and rehabilitation.