title: Can CT angiography replace conventional bi-planar angiography in the management of severe scapulothoracic dissociation injuries?
abstract: Severe scapulothoracic dissociation (SSTD) (Type III or IV; Zelle classification) is often life-threatening and is commonly associated with other devastating injuries. Rapid evaluation, including of the vascular system, is critical to limit the time to definitive therapy. CT angiography  (CTA) has evolved as a diagnostic tool, replacing angiography (angio) as it can simultaneously evaluate bony, soft tissue, and vascular injuries. We hypothesized that CTA would be useful in evaluating patients with SSTD. We retrospectively reviewed the trauma registry between June 2002 and  June 2010 to identify patients over 18 years of age who sustained SSTD. Patients that were transferred or died before diagnostic imaging were excluded. Comparisons were made between the group that underwent angio before surgery compared with CTA with regards to outcome and length of hospital  and intensive care unit stay. Fourteen patients were identified with Type III or IV SSTD over the study period. In the CTA group, mean Injury Severity Score was higher, but time to definitive operative intervention was significantly shorter. There was no difference in amputation rates or mortality.  Replacing arteriography with CTA in the preoperative workup of patients with SSTD reduces time to surgery. Despite a greater injury severity in the group in which CTA was used as the primary imaging modality, length of stay, amputation rates, and mortality were no different. CTA can be safely  used to evaluate patients with suspected SSTD.
authors.affiliation: St. Agnes Hospital, Baltimore, Maryland, USA. merchant.nishant@gmail.com
authors.forename: Nishant
authors.initials: N
authors.lastname: Merchant
authors.forename: Thomas
authors.initials: T
authors.lastname: Scalea
authors.forename: Deborah
authors.initials: D
authors.lastname: Stein
mesh_terms: D000173:Acromioclavicular Joint / Q000000981:diagnostic imaging* / Q000293:injuries*; D000328:Adult; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D000792:Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D004204:Joint Dislocations / Q000000981:diagnostic imaging* / Q000401:mortality; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012540:Scapula / Q000000981:diagnostic imaging* / Q000293:injuries*; D012782:Shoulder / Q000000981:diagnostic imaging*; D000070599:Shoulder Injuries; D013898:Thoracic Injuries / Q000000981:diagnostic imaging* / Q000401:mortality; D014057:Tomography, X-Ray Computed / Q000379:methods*