Review Question - QID 215776

Complete brachial plexus avulsions are associated with the worst outcomes for patients with scapulothoracic dissociation.

Scapulothoracic dissociation is a high-energy disruption of the scapulothoracic articulation often associated with severe neurovascular injuries, scapula fractures, and clavicular fractures. Treatment is generally open reduction internal fixation of associated fractures with urgent exploration of vascular injury. Patients with severe brachial plexus injuries have the worst outcomes.

Choo et al. performed a review of scapulothoracic dissociation. Their review found that there is an associated 10% mortality rate, 52% have a flail extremity, 21% undergo early above-elbow amputation, presence of repairable vascular injury did not adversely affect outcomes, and the clinical outcome is determined largely by the severity of the neurologic injury. They concluded that complete brachial plexus avulsion confers the worst outcomes.

Clements et al. described a case report of scapulothoracic dissociation. They defined the injury as a constellation of lateral displacement of the scapula with separation of the clavicular articulations with or without fracture of the clavicle, nerve injury (cervical root avulsion or brachial plexus injury), and arterial disruption (subclavian or axillary artery). For flail extremities (having brachial plexus avulsion), they recommend above-elbow amputation.

Illustration A demonstrates the Zelle classification of scapulothoracic dissociation. Illustration B shows a scapulothoracic dissociation evident on this radiograph.

Incorrect Answers:
Answer 1: 21% of patients with scapulothoracic dissociation undergo early above-elbow amputation.
Answer 3: Age has not been identified as an important prognostic factor.
Answer 4: Mortality rate is 10%.
Answer 5: Vascular injuries are often repairable. When they are repairable they do not confer worse outcomes.