Scapulothoracic Dissociation Following a Fall From Standing Height: A Rare and Atypical Presentation of Severe Shoulder Girdle Injury

TL;DR

This paper presents a rare case of scapulothoracic dissociation in an elderly man caused by a minor fall, emphasizing the need for early diagnosis in atypical presentations.

Contribution

The paper reports a rare case of SD caused by low-energy trauma in an elderly patient, expanding clinical awareness of atypical injury mechanisms.

Findings

SD occurred in a 93-year-old male after a fall from standing height, not high-energy trauma.

The patient showed significant neurological improvement and regained shoulder function within five months.

CT scans confirmed the injury without major vascular complications, guiding conservative treatment.

Abstract

Scapulothoracic dissociation (SD) is a rare and severe injury, typically associated with high-energy trauma. It is characterized by scapular displacement, often leading to neurovascular compromise. SD resulting from low-energy mechanisms, such as a fall from standing height, is exceptionally rare. We present the case of a 93-year-old male who sustained SD after a fall from standing height. He was hemodynamically unstable upon arrival, with progressive neurological deficits in the right upper limb. Computed tomography (CT) revealed an isolated right scapular glenoid fracture with lateral scapular displacement and a large hematoma, while CT angiography ruled out major vascular injury. Conservative management included hemodynamic stabilization and immobilization with a Velpeau-type splint. One month post-injury, neurological function in the affected upper extremity had significantly improved. By five months, the patient had regained nearly full, painless shoulder range of motion without neurological deficits. Although SD is classically associated with high-energy trauma, this case highlights its occurrence following minor trauma in elderly patients. Clinicians should maintain a high index of suspicion for SD in atypical presentations to facilitate early diagnosis and optimize treatment.

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