Trauma

Scapulothoracic Dissociation

TraumathinKbox SBA

Incidence

Rare but severe injury

Mechanism

High energy MVA 90%
Traction injury of arm

Pathoanatomy

Scapulothoracic articulation is avulsed
Clavicle fracture or ACJ disruption occurs
Effectively a traumatic, internal forequarter amputation

Associated Injuries

10% incidence of death
80% complete plexus injury
80% vascular injury
15% partial plexus injury
Chest
Spine
May be no fractures

Diagnosis

Non-rotated AP XR shows increased distance from midline
Associated clavicle fracture

Management

Reduction
Angiography as standard
Scapulothoracic fusion
Primary amputation
Decision making determined by:
- Degree of plexus injury
- Degree of vascular injury

Outcome

Poor
Best determined by presence of complete plexus injury

Related FRCS revision notes

Trauma Severity Scores Arterial Injury Scapula Fractures Foot Drop Shoulder Axial Cervical Spine Trauma

Linked from

← Trauma ← Arterial Injury ← Brachial Plexus Injuries ← Hemiarthroplasty for Proximal Humerus Fracture ← Scapula Fractures ← Trauma Severity Scores ← Fingertip injury ← Trauma communication

Written/reviewed by Kishore Puthezhath

Professor of Orthopaedics and Consultant Paediatric Orthopaedic Surgeon

FRCS (Tr & Orth) revision resource

Reviewed: September 2026

Core revision references: Miller's Review of Orthopaedics; Campbell's Operative Orthopaedics; Orthobullets. Current specialty guidelines are linked within individual notes where applicable.