A Paradoxical Triad: Scapulothoracic Dissociation with Clavicle and Humeral Shaft Fractures

Abstract

Scapulothoracic dissociation involves varying degree of discontinuity of the upper extremity from its truncal attachment. An eighteen-year-old male presented to the accident and emergency department following a motor vehicle accident where he was hit by a four wheeler while riding a two wheeler. He had tenderness and deformity over the left clavicle and the left humerus. He was unable to perform active wrist and finger dorsiflexion. A CT subsequently revealed a grade 2 splenic laceration. The splenic laceration was treated conservatively. As his general condition improved, he was gradually weaned off the ventilator and his left upper limb neurology was reassessed. He had isolated radial nerve palsy with an otherwise intact brachial plexus. He underwent internal fixation of the clavicle and the humerus. At 4 months after injury the EMG/NCV report showed signs of renervation of the radial nerve, and the fracture progressed to an uneventful union. This prior unreported triad of scapulothoracic dissociation with ipsilateral clavicular and humeral fractures may represent a parody. An apparent increase in the severity of skeletal injury was associated with a paradoxical decrease in the severity of neurovascular injury. We report this case to create awareness among orthopedic surgeons and emergency physicians about the clinical presentation of such injuries.

Two Case Presentations of Scapulothoracic Dissociation with a Range of Features and Approaches to Management: A 26-Year-Old Woman Injured in a Car Accident and a 52-Year-Old Woman Injured While Cycling

“…Moreover, a simultaneous extremity fracture is not rare, with a coincidence of humerus, radius, ulna, and hand fractures of 41% in patients with SD [ 8 , 15 ]. Similar published studies have reported cases of concomitant humeral and forearm fractures [ 3 , 9 , 16 ] that were surgically treated in the same stage with the SD, and once the critical phase was under control.…”

“…Concerning the treatment of bony injuries, there are no widely accepted treatment guidelines in the literature. Many authors prefer to proceed firstly to ORIF of the clavicle fracture, this way, protecting the underlying vascular and neurological repair [ 3 , 9 , 16 ]. The same was performed in both of our cases.…”