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
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