A stress fracture of the base of the acromion: a case report

Malavolta, Eduardo Angeli; Assunção, Jorge Henrique; Sunada, Edwin Eiji; Gracitelli, Mauro Emílio Conforto; Neto, Arnaldo Amado Ferreira

doi:10.1186/1471-2474-15-302

Cited by 12 publications

(6 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Fractures of the acromion and the scapular spine are uncommon in individuals with normal shoulders [ 35 , 36 ] or anatomic prostheses but are frequently encountered in patients with reverse shoulder prostheses. The fracture rate after RSA averages 4 to 5% [ 37 – 39 ] and ranges from 0.5% [ 40 ] to 25% [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Causes of acromion and scapular spine fractures following reverse shoulder arthroplasty: a retrospective analysis and literature review

Nyffeler

Altioklar

Bissig

2020

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

Purpose Fractures of the acromion and the scapular spine are serious complications after reverse total shoulder arthroplasty. They concern about 4 to 5% of the patients and always result in a significant deterioration of shoulder function. Different causes have been taken into consideration, particularly stress or fatigue fractures. The purpose of the present study was to analyse our own cases and to discuss the causes reported in the literature. Methods We reviewed our shoulder arthroplasty registry and the consultation reports of the last ten years. The charts and radiographs of all patients who had a post-operative fracture of the acromion or the scapular spine were carefully examined and the results were compared with those of an age- and gender-matched control group. Results Twelve patients with an average age of 79 years sustained a fracture of the acromion (n = 6) or the scapular spine (n = 6). The time interval between the operation and the fracture averaged 26 months and ranged from three weeks to 70 months. Eight patients (67%) had a trauma. Seven of them reported a fall on the corresponding shoulder and one a heavy blow on the acromion. The four non-traumatic fractures were attributed to poor bone quality. All 12 patients had immediate pain and difficulty to actively elevate the affected arm. The time interval between the fracture and its diagnosis averaged ten weeks (0 to 10 months). At final follow-up, all patients could reach their face and refused further surgery. Two patients rated their result as good, six as acceptable and four as poor. Conclusions Our study cannot support the hypothesis that most acromion and scapular spine fractures after RSA are the result of increased tension in the deltoid or stress fractures. In our series, the majority of the fractures were related to a fall. Implantation of a reverse prosthesis exposes the acromion and makes it more vulnerable to direct trauma. Non-traumatic fractures were associated with poor bone quality.

show abstract

Section: Discussionmentioning

confidence: 99%

Causes of acromion and scapular spine fractures following reverse shoulder arthroplasty: a retrospective analysis and literature review

Nyffeler

Altioklar

Bissig

2020

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

show abstract

“…However, while the acromion is a relatively small and irregularly quadrangular bone in anatomical terms, the term ‘acromion’ is used surgically and clinically to indicate a much larger region [ 16 ]. There is an inconsistency in the nomenclature for acromion fracture in the literature [ 17 – 19 ]. Some authors consider only the area of the anterior bony protrusion from the lateral scapular spine as the acromion, while the rest is referred to as the lateral extension of the scapular spine, or more simply as the scapular spine [ 14 , 15 , 20 – 33 ].…”

Section: Introductionmentioning

confidence: 99%

Nonunion of the so-called acromion: a systematic review with consideration of the terminology

Ogawa

Matsumura

Yoshida

et al. 2023

Arch Orthop Trauma Surg

View full text Add to dashboard Cite

Introduction There is no widely accepted standard for the classification and treatment of traumatic acromion/scapular spine fracture nonunion due to the scarcity of this condition and the confusion of terminology. Materials and methods PubMed and Scopus were searched using “scapular fracture” and “acromion fracture” or “scapular spine fracture” as search terms. The inclusion criteria were English full-text articles concerning acromion/scapular spine fracture nonunion that described patient characteristics and presented appropriate images. The exclusion criteria were cases without appropriate images. Citation tracking was conducted to find additional articles and notable full-text articles written in other languages. Fractures were classified using our newly proposed classification system. Results Twenty-nine patients (19 men, 10 women) with 29 nonunions were identified. There were four type I, 15 type II, and 10 type III fracture nonunions. Only 11 fractures were isolated. The mean period from initial injury to final diagnosis was 35.2 ± 73.2 months (range 3–360 months) (n = 25). The most frequent cause of delayed diagnosis was conservative treatment for fracture in 11 patients, followed by oversight by the physician in 8. The most common reason for seeking medical advice was shoulder pain. Six patients received conservative therapy, and 23 received operative treatment. Fixation materials included various plates in 15 patients, and tension band wiring in 5. Bone grafting was performed in 16 patients (73%, 16/22). Of the 19 surgically treated patients with adequate follow-up, the outcome was rated excellent in 79%. Conclusions Isolated acromion/scapular spine fracture nonunion is rare. Fracture type II and III, arising in the anatomical scapular spine, accounted for 86% of the fractures. Computed tomography is required to prevent fracture oversight. Surgical therapy produces good stable results. However, it is important to select the appropriate surgical fixation method and material after considering the anatomical characteristics of the fracture and stress on the fractured portion. Level of evidence V

show abstract

“…However, it is hypothesized in the literature that symptoms from a base of the acromion fracture are unique because the mechanical pull from both deltoid and trapezius results in more symptoms, tendency for instability, and puts the patient at an increased risk of developing pseudoarthrosis. 4 , 9 …”

mentioning

confidence: 99%

“…Described surgical techniques for these fractures include plates and screws, and tension band wiring with or without bone grafting. 4 , 9 Malavolta et al 4 used a standard 6-hole Locking Compression Plate (LCP) with locking screws to achieve the necessary fixation of a fractured acromion. More recently, Kurahashi et al 3 reported the use of a “mesh plate” in 2 acute cases.…”

mentioning

confidence: 99%

Use of an anterolateral distal tibia Locking Compression Plate for the management of acromion pseudoarthrosis in an osteogenesis imperfecta patient: a case report

A stress fracture of the base of the acromion: a case report

Cited by 12 publications

References 12 publications

Causes of acromion and scapular spine fractures following reverse shoulder arthroplasty: a retrospective analysis and literature review

Causes of acromion and scapular spine fractures following reverse shoulder arthroplasty: a retrospective analysis and literature review

Nonunion of the so-called acromion: a systematic review with consideration of the terminology

Use of an anterolateral distal tibia Locking Compression Plate for the management of acromion pseudoarthrosis in an osteogenesis imperfecta patient: a case report

Contact Info

Product

Resources

About