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The scapulothoracic dissociation (SD) is a complex injury of the shoulder girdle, mostly associated with polytraumatized critically ill patients. This case report of 3 patients shows the variety of possible injuries combined with SD. Diagnosis and therapy in such a rare trauma, which is most likely seen in specialized trauma centres are being described. The 3 patients are presented from trauma to management, with remarks to various possibilities in treatment. Reports of other groups include multicenter studies with small numbers of patients, making it different to look for homogenity or defining standards, whereas current guidelines are being mentioned, including remarks on the management of these mostly polytraumatized and vitally endangered patients.