Scapulothoracic dissociation secondary to major shoulder trauma.

Three skeletally immature patients with scapulothoracic dissociation were reviewed. A 5-year-old child's arm, caught in a conveyor belt, led to complete upper extremity amputation. Multiple fractures, muscular damage, and cutaneous and subcutaneous tissue disruption (degloving) were present throughout the avulsed extremity. Replantation was considered, but not carried out because of these extensive injuries. He was treated with a myoelectric prosthesis. Two older boys had scapulothoracic dissociation (one open, one closed) associated with clavicular diaphyseal fractures following blunt trauma. In each case, the clavicle was stabilized, muscular disruptions were reattached, and bleeding was controlled locally, although no specific major vascular repair was required. There was no return of neurologic function, leaving each patient with a flail upper extremity. One patient and his family eventually elected to have a shoulder disarticulation followed by fitting with a myoelectric prosthesis. The other patient still had a flail extremity at his last evaluation 17 months postinjury, but did not return for subsequent evaluation.