Scapulothoracic dissociation: a rare injury with scapular comminuted fracture and intact clavicle

Introduction Scapulothoracic dissociation is a high-energy injury of the upper limb, often misdiagnosed due to associate traumas. Material The patient was a 37-year-old male who sustained a car accident. He was well oriented and classified as GS:15/15. He complained for a right arm pain and numbness and able to make small movements bellow elbow. A complete clinico-radiological examination was performed. Blood tests were normal except saturation which was declining. The patient collapsed in the emergency department and underwent emergency intubation. Results The patient had multiple right rib fractures, scapula comminuted fracture, lung distress syndrome, hemothorax and extensive hematoma around the right shoulder, right neck area and ventral thoracic wall. The increased scapulothoracic index confirmed the speculation of scapulothoracic dissociation. Conservative management was decided that time. Further investigation was requested just after the patient became stable, but he died 15 days later due to acute respiratory distress syndrome (ARDS). Conclusion Scapulothoracic dissociation is a rare injury, and the prognosis is mainly related with brachial plexus avulsion.