Scapulothoracic Dissociation: a Systematic Review, Current Concepts, and Meta-analysis of Case Reports

Abstract

Scapulothoracic dissociation is a rare entity which is frequently associated with arterial and brachial plexus injuries. It is frequently missed especially in the scenario of polytrauma. To examine the incidence, mode and mechanism of injury, associated injuries, diagnosis, treatment protocol, and existing current concepts in the literature. Ovid MEDLINE from January 1980 to August 2019. Published case reports/case series/observational studies. Patient characteristics were summarized descriptively. Appropriate statistical tests were applied. 54.3% of the patients between the age group of 20 and 40 with a male to female ratio of 6.2. In 51.9% of the cases, motorcycle accident was the mode of injury. 68.7% of the cases were associated with vascular injuries either at the level of subclavian or axillary. Brachial plexus involvement was seen in 86.1% of the cases. Isolated fracture of the clavicle was found in 53.9% of the cases. In 13.6% of the patients, scapulothoracic dissociation was associated with polytrauma. Zelle type 4 injuries were the commonest (51.9%). One-fourth of the patients were managed conservatively. Primary amputation was done in 15% of the cases. Mortality rate was about 10%. About 46% of the patients landed up in flail limb or amputation. The most significant predictors of the functional outcome were vascular injury, brachial plexus injury, and classification type. Polytrauma was the most significant predictor of mortality. The results from this systematic review have revealed the most common age group involved, mode of injury, and prognostic indicators and helped in the formulation of treatment protocol in the management of this rare but devastating injury which can be easily missed especially in the polytrauma scenarios.