{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T22:04:12Z","timestamp":1773871452079,"version":"3.50.1"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2019,12,1]],"date-time":"2019-12-01T00:00:00Z","timestamp":1575158400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec>\n            <jats:title>Abstract<\/jats:title>\n            <jats:p>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.<\/jats:p>\n            <jats:p>\n                                 <jats:bold>Level of Evidence:<\/jats:bold> V<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/oi9.0000000000000048","type":"journal-article","created":{"date-parts":[[2019,12,18]],"date-time":"2019-12-18T16:10:58Z","timestamp":1576685458000},"page":"e048","source":"Crossref","is-referenced-by-count":2,"title":["Critical ischemia and myonecrotic sepsis following scapulothoracic dissociation in the setting of apparent hand perfusion"],"prefix":"10.1097","volume":"2","author":[{"given":"Joseph T.","family":"Labrum","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Rehabilitation"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mihir J.","family":"Desai","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Rehabilitation"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas C.","family":"Naslund","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery, Department of Surgery, Vanderbilt Medical Center, Nashville, TN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William T.","family":"Obremskey","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Rehabilitation"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2019,12]]},"reference":[{"key":"R1-20230823","doi-asserted-by":"crossref","first-page":"758","DOI":"10.2106\/00004623-198466050-00016","article-title":"Traumatic lateral displacement of the scapula: a radiographic sign of neurovascular disruption","volume":"66","author":"Oreck","year":"1984","journal-title":"J Bone Joint Surg."},{"key":"R2-20230823","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1097\/00003086-198608000-00031","article-title":"Scapulothoracic dissociation. A case report","volume":"209","author":"Kelbel","year":"1986","journal-title":"Clin Orthop Relat Res."},{"key":"R3-20230823","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1016\/j.injury.2004.12.053","article-title":"Scapulothoracic dissociation: evaluation and management","volume":"36","author":"Brucker","year":"2005","journal-title":"Injury."},{"key":"R4-20230823","first-page":"14","article-title":"Scapulothoracic dissociation: level of vascular insult, an indirect prognostic indicator for the final outcome?","volume":"75","author":"Sen","year":"2009","journal-title":"Acta Orthop Belg."},{"key":"R5-20230823","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1097\/00005373-199703000-00024","article-title":"Scapulothoracic dissociation caused by blunt trauma","volume":"42","author":"Damschen","year":"1997","journal-title":"J Trauma."},{"key":"R6-20230823","doi-asserted-by":"crossref","first-page":"2","DOI":"10.2106\/00004623-200401000-00002","article-title":"Functional outcome following scapulothoracic dissociation","volume":"86","author":"Zelle","year":"2004","journal-title":"J Bone Joint Surg."},{"key":"R7-20230823","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.ijscr.2019.07.061","article-title":"Subclavian artery avulsion following blunt trauma: a case report and literature review","volume":"61","author":"Elkbuli","year":"2019","journal-title":"Int J Surg Case Rep."},{"key":"R8-20230823","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1016\/0741-5214(93)90679-G","article-title":"The neurovascular outcome of scapulothoracic dissociation","volume":"17","author":"Sampson","year":"1993","journal-title":"J Vasc Surg."},{"key":"R9-20230823","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1097\/00005131-199308000-00013","article-title":"Traumatic lateral scapular displacement: an expanded spectrum of associated neurovascular injury","volume":"7","author":"Lange","year":"1993","journal-title":"J Orthop Trauma."},{"key":"R10-20230823","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1097\/00005131-198701010-00003","article-title":"Scapulothoracic dissociation (closed avulsion of the scapula, subclavian artery, and brachial plexus): a newly recognized variant, a new classification, and a review of the literature and treatment options","volume":"1","author":"Ebraheim","year":"1987","journal-title":"J Orthop Trauma."},{"key":"R11-20230823","doi-asserted-by":"crossref","first-page":"339","DOI":"10.5435\/JAAOS-D-15-00509","article-title":"Scapulothoracic dissociation: evaluation and management","volume":"25","author":"Choo","year":"2017","journal-title":"JAAOS."},{"key":"R12-20230823","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1097\/TA.0000000000001645","article-title":"Contemporary management of subclavian and axillary artery injuries: a western trauma association multicenter review","volume":"83","author":"Waller","year":"2019","journal-title":"J Trauma Acute Care Surg."},{"key":"R13-20230823","doi-asserted-by":"crossref","first-page":"54","DOI":"10.5704\/MOJ.1507.002","article-title":"The flail and pulseless upper limb: an extreme case of scapula-thoracic dissociation","volume":"9","author":"Maria","year":"2015","journal-title":"Malays Orthop J."},{"key":"R14-20230823","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1177\/153857440103500108","article-title":"Subclavian arterial injury associated with blunt trauma","volume":"35","author":"Katras","year":"2001","journal-title":"Vasc Surg."},{"key":"R15-20230823","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1001\/archsurg.1971.01350040154030","article-title":"Collateral circulation in arterial injuries","volume":"102","author":"Levin","year":"1971","journal-title":"Arch Surg."}],"container-title":["OTA International: The Open Access Journal of Orthopaedic Trauma"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/OI9.0000000000000048","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,23]],"date-time":"2023-08-23T03:07:50Z","timestamp":1692760070000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/OI9.0000000000000048"}},"subtitle":["A case report"],"short-title":[],"issued":{"date-parts":[[2019,12]]},"references-count":15,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2019]]}},"URL":"https:\/\/doi.org\/10.1097\/oi9.0000000000000048","relation":{},"ISSN":["2574-2167","2574-2167"],"issn-type":[{"value":"2574-2167","type":"print"},{"value":"2574-2167","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,12]]}}}