Incidence, radiographic predictors, and clinical outcome of acromial stress reaction and acromial fractures in reverse total shoulder arthroplasty

Kriechling, Philipp; Hodel, Sandro; Paszicsnyek, Alexander; Schwihla, Ines; Borbas, Paul; Wieser, Karl

doi:10.1016/j.jse.2021.11.012

Cited by 19 publications

(12 citation statements)

References 41 publications

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“…Another interesting finding of our study is that the E-RTSA group had a high incidence of acromial fractures (9%). This fits well to the findings of Kriechling et al [ 36 ], who published an overall rate of about 10% of acromial stress reactions including acromial stress fractures after primary RTSA. This may be caused by an earlier and faster recovery resulting in higher tension applied earlier on the deltoid in comparison to the F-RTSA group [ 5 ].…”

Section: Discussionsupporting

confidence: 92%

Reverse Total Shoulder Arthroplasty for Proximal Humeral Fractures and Sequalae Compared to Non-Fracture Indications: A Matched Cohort Analysis of Outcome and Complications

Paszicsnyek

Kriechling

Razaeian

et al. 2023

JCM

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Background: With the increase in utility and popularity of the reverse total shoulder arthroplasty (RTSA) within the last decades, indications for RTSA have expanded. As well as the established indications such as cuff tear arthropathy and massive irreparable rotator cuff tears, RTSA for complex proximal humeral fractures in elderly patients has been proven to be a reliable treatment option. Methods: A prospectively enrolled RTSA database of 1457 RTSAs implanted between September 2005 and November 2020 was reviewed. Patients treated with RTSA for a complex proximal humerus fracture and fracture sequalae (F-RTSA) were 1:1 matched with a group of patients who were treated electively with RTSA for indications other than a fracture (E-RTSA). Matching criteria included sex, age, length of follow-up and body mass index. Evaluation after a minimum of 2 years follow-up included evaluation of the absolute and relative Constant–Murley score (aCS; rCS), subjective shoulder value (SSV), range of motion (ROM) assessment and complications. Results: Each of the matched cohorts comprised 134 patients with a mean follow-up of 58 ± 41 months for the fracture group and 58 ± 36 months for the elective group. The mean age for both groups was 69 ± 11 years in the F-RTSA and 70 ± 9 years for the E-RTSA group. There were no significant differences in clinical outcome measures including aCS, rCS and SSV (p > 0.05). There was a significant difference in mean active external rotation with 20° ± 18° in the F-RTSA group compared with 25° ± 19° in the E-RTSA group (p = 0.017). The complication rate was not significantly different, with 41 complications in 36 shoulders in the F-RTSA and 40 complications in 32 shoulders in the E-RTSA group (p = 0.73). The main complication for the F-RTSA group was dislocation of the greater tuberosity (6%), whereas acromial fractures (9%) were the leading complication in the E-RTSA group. There was also no significant difference in revision rate comparing F-RTSA with E-RTSA (10% vs. 14%; p = 0.25). Conclusions: RTSA for complex proximal humeral fractures and its sequalae leads to a comparable clinical outcome as that for patients treated electively with RTSA for indications other than fracture. There was, however, a significant difference in active external rotation, with inferior rotation in patients undergoing RTSA for fracture. This valuable information can help in requesting informed consent of patients with proximal humeral fractures.

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Section: Discussionsupporting

confidence: 92%

Reverse Total Shoulder Arthroplasty for Proximal Humeral Fractures and Sequalae Compared to Non-Fracture Indications: A Matched Cohort Analysis of Outcome and Complications

Paszicsnyek

Kriechling

Razaeian

et al. 2023

JCM

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“… 5 Small sample sizes and sparse research may contribute to the lack of consensus on how to manage these fractures nonsurgically. 3 , 16 , 18 Thus, new modalities warrant investigation. Our limited case series demonstrates that after the completion of intranasal calcitonin treatment, the mean VAS, AROM, and ASES scores all markedly improved compared with those at fracture presentation.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical management of AF/SSFs is associated with markedly higher rates of bony union than nonsurgical approaches; however, this is not accompanied by notable improvement in clinical outcomes when compared with standard conservative approaches. 3 , 16 - 18 In conjunction, surgical management of AF/SSFs is thought to have a high rate of failure. 5 The currently accepted practices for noninvasive management of AF/SSF involves cessation of physical therapy and immobilization.…”

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confidence: 99%

Safety and Early Results for Off-Label Use of Intranasal Calcitonin for Treatment of Nondisplaced Acromial and Scapular Spine Stress Fractures After Reverse Total Shoulder Arthroplasty

Mandalia,

Gulotta,

Ross

et al. 2024

JAAOS Glob Res Rev

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Immobilization for acromial and scapular spine stress AU4fractures (AF/SSF) after reverse total shoulder arthroplasty (RSA) is associated with patient dissatisfaction. Our study reports the effects and safety of intranasal calcitonin alongside sling immobilization on pain and function in the treatment of AF/SSF after RSA. The treatment was regimented calcitonin (salmon) 200 unit/actuation nasal spray (1 spray/day) for 6 weeks with sling immobilization for 4 weeks. Each patient was monitored through blood work. Visual analog scale, American Shoulder and Elbow Surgeons score, and active range of motion were collected preoperatively, postoperatively, at presentation of AF/SSF, and after completion of calcitonin treatment. Two hundred eighty-two RSAs were performed by two board-certified orthopaedic surgeons, of which 18 patients sustained AF/SSF (6.4%). Ten patients met inclusion criteria (nine AFs and one SSF). After calcitonin treatment, patients demonstrated an average improvement of visual analog scale of 5.8 points, active range of motion of 46_, and American Shoulder and Elbow Surgeons score of 43.6 points at average 7.53 months after RSA. No medical complications were reported at 6-month follow-up after calcitonin treatment. The use of intranasal calcitonin was not associated withadverse events including no aberrations/signs of cancer at 6-month follow-up after administration. Calcitonin with sling immobilization markedly improved clinical and functional outcomes of patients with nondisplaced AF/SSF and may be considered by orthopaedic surgeons for symptom management.

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“…Acromial insufficiency fractures after reverse shoulder arthroplasty result in worse clinical outcomes when compared to controls, regardless of whether the fracture is treated operatively or nonoperatively. 15 Significant research has focused on defining the rate of AIF. Early studies reported acromion and scapular spine fracture rates near 7-10%, though these studies included small patient numbers from single institutions.…”

Section: Discussionmentioning

confidence: 99%

Low acromial insufficiency fracture rate in reverse shoulder arthroplasty with distal clavicle excision

et al. 2023

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Background This study investigated the rate of acromial insufficiency fractures (AIF) in patients undergoing reverse shoulder arthroplasty (RSA) with concomitant distal clavicle excision (DCE). Methods Patients who underwent primary RSA with DCE by a single surgeon from 2010 to 2021 were identified. Exclusion criteria included revision RSA, RSA for fracture, or cases utilizing an augmented baseplate or bone graft. AIF was defined as a radiographically proven acromion or scapular spine fracture. Pain without an identifiable fracture on imaging was defined as an acromial insufficiency reaction. Patient demographics, implant information, and radiograph measurements were compared between patients with and without acromial pathology. Results One hundred and seventy-five patients were included. Mean age was 72.8 years, and 67% of patients were female. There were 3/174 acromial insufficiency fractures (1.7%). AIF occurred at a mean of 9.3 months after surgery. Twelve patients had insufficiency reactions (6.9%). Patients with acromial pathology were more likely to be female ( p = .003) and have a diagnosis of osteoporosis ( p = .047) and inflammatory arthritis ( p = .049). There was no significant difference between groups in terms of other factors. Conclusion The AIF rate in patients who underwent RSA with DCE was 1.7%. These findings suggest that DCE in the setting of RSA may have a protective role against AIF.

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Incidence, radiographic predictors, and clinical outcome of acromial stress reaction and acromial fractures in reverse total shoulder arthroplasty

Cited by 19 publications

References 41 publications

Reverse Total Shoulder Arthroplasty for Proximal Humeral Fractures and Sequalae Compared to Non-Fracture Indications: A Matched Cohort Analysis of Outcome and Complications

Reverse Total Shoulder Arthroplasty for Proximal Humeral Fractures and Sequalae Compared to Non-Fracture Indications: A Matched Cohort Analysis of Outcome and Complications

Safety and Early Results for Off-Label Use of Intranasal Calcitonin for Treatment of Nondisplaced Acromial and Scapular Spine Stress Fractures After Reverse Total Shoulder Arthroplasty

Low acromial insufficiency fracture rate in reverse shoulder arthroplasty with distal clavicle excision

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