Scapulothoracic dissociation and degloving injuries of the extremities

Scapulothoracic dissociation is an uncommon and an extremely complex and morbid injury with significant morbidity and mortality; however, degloving injuries and open upper extremity injuries and open fractures are considerably more common Scapulothoracic dissociation and upper extremity fractures are caused by high impact trauma. Proper care begins with the initial assessment of this injuries in the pre-hospital arena including hemorrhage control and rapid transport along with prompt transport to a trauma center where initial evaluation and resuscitation includes intravascular volume replacement, assessment of all components of the injured or wounded extremity including vascular, neural, and musculoskeletal components along with the evaluation for the presence of a compartment syndrome, fracture reduction, immediate antibiotic administration (so important to prevent infections), temporary wound coverage, and transport to the operating room for washout and external fixation and/or definitive open reduction and internal fixation (ORIF). Their care usually requires a combined team approach consisting of trauma, orthopedic, plastic surgeons, and neurosurgeons.