A polytraumatized patient with one or more mangled extremities presents challenges to the clinical team on multiple levels. Management of the mangled extremity requires rapid revascularization coupled with aggressive debridement. Fasciotomy should be generous in nature to ensure optimum flow. Multifunctional fixation, anatomic reduction, and appropriate wound access with elevation of the extremity are tenants in orthopedic management in trauma that includes bony and vascular injury. Special consideration should be paid to injuries associated with particular mechanisms of injury. Scapulothoracic dissociation of the upper extremity is associated with high-energy blunt trauma to the forequarter and is often avulsive in nature. Injuries include disruption of vascular flow to the upper extremity, lateral displacement of the scapula, and disruption of the sternal-clavicular-acromial axis. The brachial plexus is frequently injured in this complex, resulting in abnormal neurological findings, frequently permanent.
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