Scapulothoracic Dissociation in Contemporary Practice: Revisiting Clinical Reality Through the Trauma Quality Improvement Program

BackgroundScapulothoracic dissociation is a rare, limb-, and potentially life-threatening injury in which the scapula and shoulder girdle are violently detached from the thoracic cage. However, the published data on the condition is mainly composed of case reports and single institution samples, which limits the overall generalizability. The aim of the current investigation was consequently to use a multi-institutional data set to characterize the injuries observed in patients with scapulothoracic dissociation along with the treatment strategies selected.MethodsThe 2016-2021 Trauma Quality Improvement Project (TQIP) database was used to identify cases of scapulothoracic dissociation. Patients were grouped based on the presence of neurovascular injury. The statistical significance of differences between the cohorts was determined using the Mann-Whitney U-test, chi-squared test, or Fisher's exact test, as appropriate.ResultsAfter applying the inclusion criteria, 74 cases of scapulothoracic dissociation were detected in the TQIP database; of these, 20% (N = 15) also suffered a neurovascular injury. The majority of patients with scapulothoracic dissociation without neurovascular injury could be managed non-operatively, while this was only the case for a minority with neurovascular injury (71.2% vs 26.7%, <i>P</i> = 0.004). Among patients who were ≥60 years old without neurovascular injury (N = 13), 92.3% (N = 12) could be managed non-operatively. Of those with neurovascular injury, 46.7% required internal fixation, 40% underwent vascular surgery, and 20% necessitated upper arm or forequarter amputation.ConclusionWhile scapulothoracic dissociation can be a serious, debilitating injury, most cases don't result in neurovascular injury and can often be managed non-operatively, particularly among the elderly.