Scapulothoracic dissociation with subclavian artery dissection following a severe motorbike accident.

A 52-year-old motorbike driver was struck by a trailer. His left shoulder was swollen and no pulse was evident at his left wrist. In the emergency room, a scapulothoracic dissociation with subclavian artery dissection and a complex fracture of the humerus were evident (Fig. 1). Carotido-subclavian bypass restored blood flow with preservation of the arm in follow-up (Fig. 2). Fig. 1. 3D-computer tomography with reformation demonstrating the sterno-clavicular dislocation at the left side with dissection of the subclavian artery 2 cm distal to the vertebral artery, fracture of the scapula at the inferior margin, and refill of the subclavian artery due to collaterals. Fig. 2. 3D-computer tomography six days following surgery after stabilization of the pulmonary function of the patient due to severe concomitant lung contusion demonstrating a left carotido-subclavian bypass using a saphenous vein graft for re-establishing of the left arm blood flow.