Closed forequarter amputation (scapulothoracic dissociation) is a rare, easily missed, life-threatening injury. The diagnosis should be suspected in patients with a pulseless, flail limb, supraclavicular haematoma, lateral scapular displacement and clavicular disruption. Early surgery is essential to control haemorrhage and completion of the amputation with attention to closure of the resulting defect is often required. Prognosis for long-term functional recovery is poor, in spite of modern prosthetic aids.