Labrum Joseph T, Desai Mihir J, Naslund Thomas C, Obremskey William T
Department of Orthopaedics and Rehabilitation.
Division of Vascular Surgery, Department of Surgery, Vanderbilt Medical Center, Nashville, TN.
OTA Int. 2019 Dec 13;2(4):e048. doi: 10.1097/OI9.0000000000000048. eCollection 2019 Dec.
Scapulothoracic dissociation is a rare and devastating injury to the shoulder girdle. It is often caused by traction or severe blunt trauma injury to the upper extremity and is associated with both neurologic and vascular injuries. Scapulothoracic dissociation is a highly morbid and rare injury pattern that is often seen in conjunction with other traumatic injuries. The authors describe a case of scapulothoracic dissociation with associated complete brachial plexus injury and subclavian artery injury that was complicated by hypoperfusion, myonecrosis, and subsequent polymicrobial infection of the affected limb in the setting of a warm hand with brisk capillary refill. While capillary refill and hand warmth in the setting of a pulseless extremity have been used in previous cases of scapulothoracic dissociation as an indication for limb perfusion and nonoperative management, these markers cannot reliably be used to evaluate collateral circulation as exemplified in this case report. This case highlights multiple important aspects of the evaluation and management of scapulothoracic dissociation that orthopaedic surgeons and vascular surgeons should be familiar with and utilize when dealing with these challenging injuries. V.
肩胛胸壁分离是一种罕见且严重的肩胛带损伤。它通常由上肢的牵引或严重钝性创伤引起，并伴有神经和血管损伤。肩胛胸壁分离是一种发病率高且罕见的损伤类型，常与其他创伤性损伤同时出现。作者描述了一例伴有完全性臂丛神经损伤和锁骨下动脉损伤的肩胛胸壁分离病例，该病例在手部温暖且毛细血管再充盈轻快的情况下，因灌注不足、肌坏死以及随后受影响肢体的多微生物感染而复杂化。虽然在之前的肩胛胸壁分离病例中，无脉肢体情况下的毛细血管再充盈和手部温暖被用作肢体灌注和非手术治疗的指标，但如本病例报告所示，这些指标不能可靠地用于评估侧支循环。本病例突出了肩胛胸壁分离评估和治疗的多个重要方面，骨科医生和血管外科医生在处理这些具有挑战性的损伤时应熟悉并加以运用。V.
