Scapulothoracic Dissociation and Clavicle Fracture with Associated Brachial Plexus Palsy.

Scapulothoracic dissociation is the traumatic separation of the scapula from the thoracic wall. It is the outcome of rare, high-energy trauma to the shoulder girdle and may include vascular and neurologic damage of the upper extremity. Of the few cases presented in the literature, the majority refer to polytrauma patients. We present a rare variant of scapulothoracic dissociation combined with comminuted fractures of both the scapula and the clavicle associated with brachial plexus palsy. There were also vertebral fractures of the spinous processes of C6, T4, T5, and T6, of the transverse processes of T1 and T2, and of the anterior and middle column of T12. An open reduction and internal fixation of the clavicle was performed, and the patient was hospitalized in the intensive care unit and on the ward. The patient had a good recovery, involving extensive physiotherapy during hospitalization and after discharge to a rehabilitation center. Scapulothoracic dissociation can have potentially disastrous implications. The diagnosis is sometimes challenging because it usually involves polytrauma patients who have multiple life-threatening injuries. The diagnosis and management of this injury is of significant importance, and immediate surgical intervention should be performed when required.

SEPSIS SECONDARY TO DELAYED PRESENTATION OF NECROTISING FASCIITIS OF THE THIGH-PRESENTATION OF TWO CASES WITH A POOR OUTCOME.

Necrotizing fasciitis is an extremely virulent form of infectious fasciitis. It affects skin, subcutaneous fat, and superficial and deep muscular fascia by rapidly progressive necrosis. We present two cases, a 54-year-old female patient and a 46-year-old male patient, who presented to the emergency department of our hospital 30 days and 14 days after the onset of symptoms, respectively, with progressively deteriorating pain and swelling of the thigh, accompanied by fever, nausea, sweating, shortness of breath, and sepsis. Clinical, laboratory, and imaging findings suggested thigh fasciitis, which was secondary to osteomyelitis of the femoral head in one case. Despite the urgent surgical exploration and debridement, multiple courses of various schemes of intravenous antibiotics administered, the numerous surgical debridements and interventions performed, and the prolonged hospitalization in the intensive care unit, both patients died due to multiple-organ failure and disseminated intravascular coagulation. Necrotizing fasciitis is of surgical urgency with a high mortality rate, and early surgical intervention is of vital importance. In both of these cases, delayed presentation to the hospital was of great significance to the final outcome.