Two Case Presentations of Scapulothoracic Dissociation with a Range of Features and Approaches to Management: A 26-Year-Old Woman Injured in a Car Accident and a 52-Year-Old Woman Injured While Cycling

Case series Patients: Female, 26-year-old • Female, 52-year-old Final Diagnosis: Scapulothoracic dissociation Symptoms: Pain, numness Medication: — Clinical Procedure: — Specialty: Orthopedics and Traumatology OBJECTIVE: Rare disease BACKGROUND: Scapulothoracic dissociation (SD) is caused by a high-energy trauma that results in disruption of the scapulothoracic articulation, scapula and clavicular fracture, and severe neurovascular injury. This report describes 2 cases of traumatic SD with a range of features and approaches to management, a 26-year-old woman injured in a car accident and a 52-year-old woman injured while cycling. CASE REPORTS: Case 1. A 26-year-old woman sustained an SD due to a car accident. A high index of suspicion led to the diagnosis, since there was a subtle clinical presentation. Open reduction and internal fixation (ORIF) of the clavicle was performed and the postoperative course was uncomplicated. Case 2. A 52-year-old woman was hit by a car while cycling and sustained multiple trauma injuries including a simultaneous brachial plexus injury and central cord syndrome, making the diagnosis of both entities a challenge. ORIF of the clavicle was performed and the brachial plexus was treated in a second stage. At the time of this report, the prognosis was poor. CONCLUSIONS: These cases have shown that the accurate diagnosis of SD requires a high index of suspicion and a detailed clinical examination and imaging, since there is a range of presentations and anatomic findings. Rapid treatment is crucial in preventing limb deformity and neurological damage and saving the patient’s life.