Scapulothoracic Dissociation: a Systematic Review, Current Concepts, and Meta-analysis of Case Reports
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SURGERY
Scapulothoracic Dissociation: a Systematic Review, Current Concepts, and Meta-analysis of Case Reports Vishal Kumar 1 & Himanshu Bhayana 1 & Amit Kumar Salaria 1 & Deepak Neradi 1 & Sameer Aggarwal 1 & Ekta Dogra 2 Accepted: 16 November 2020 / Published online: 23 November 2020 # Springer Nature Switzerland AG 2020
Abstract Scapulothoracic dissociation is a rare entity which is frequently associated with arterial and brachial plexus injuries. It is frequently missed especially in the scenario of polytrauma. To examine the incidence, mode and mechanism of injury, associated injuries, diagnosis, treatment protocol, and existing current concepts in the literature. Ovid MEDLINE from January 1980 to August 2019. Published case reports/case series/observational studies. Patient characteristics were summarized descriptively. Appropriate statistical tests were applied. 54.3% of the patients between the age group of 20 and 40 with a male to female ratio of 6.2. In 51.9% of the cases, motorcycle accident was the mode of injury. 68.7% of the cases were associated with vascular injuries either at the level of subclavian or axillary. Brachial plexus involvement was seen in 86.1% of the cases. Isolated fracture of the clavicle was found in 53.9% of the cases. In 13.6% of the patients, scapulothoracic dissociation was associated with polytrauma. Zelle type 4 injuries were the commonest (51.9%). One-fourth of the patients were managed conservatively. Primary amputation was done in 15% of the cases. Mortality rate was about 10%. About 46% of the patients landed up in flail limb or amputation. The most significant predictors of the functional outcome were vascular injury, brachial plexus injury, and classification type. Polytrauma was the most significant predictor of mortality. The results from this systematic review have revealed the most common age group involved, mode of injury, and prognostic indicators and helped in the formulation of treatment protocol in the management of this rare but devastating injury which can be easily missed especially in the polytrauma scenarios. Keywords Scapulothoracic . Dissociation . Brachial plexus . Axillary . Subclavian
Introduction Scapulothoracic dissociation—first identified by Oreck et al.—is an infrequent but potentially limb-threatening injury with a mortality rate of about 11% [1, 2]. Scapulothoracic dissociation includes a spectrum of injuries having osseous, muscular, vascular, and neurological components [1]. The usual cause is the massive traction injury leading to the
This article is part of the Topical Collection on Surgery * Amit Kumar Salaria [email protected] 1
Department of Orthopaedics, PGIMER Chandigarh, Chandigarh 160012, India
2
Department of Community Medicine, PGIMER Chandigarh, Chandigarh, India
articular disruption of the scapulothoracic junction. Because of the extensive damage, it may be considered as partial forequarter amputation as there is brachial plexus avulsion, subclavian or axillary artery injury, and extensive muscular and osseous inj
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