Nonoperative treatment of acromial fractures following reverse shoulder arthroplasty: clinical and radiographic outcomes

Boltuch, Andrew; Grewal, Gagan; Cannon, Dylan; Polisetty, Teja S.; Levy, Jonathan C.

doi:10.1016/j.jse.2021.12.024

Cited by 15 publications

(14 citation statements)

References 20 publications

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“…In one report, Boltuch et al. 7 documented a 61% nonunion rate in 44 acromial fractures after RSA. Although some patients may have nonunions that become asymptomatic, others may continue to report burdensome continual pain and impingement, at which point surgery is considered.…”

Section: Discussionmentioning

confidence: 99%

“…Nonsurgical treatment often results in a satisfactory outcome when the anterior acromion is compromised after reverse total shoulder arthroplasty. 1 , 7 Thus, arthroscopic excision should only be considered if symptoms persist after a minimum of 3 months of conservative management. Pain without instability should be the primary indication for surgery, particularly if the patient complains of classic “impingement” symptoms with physical examination findings that corroborate that the inferiorly displaced fragment is the primary source of pain (e.g., direct tenderness to palpation of the fragment, pain with active or passive arm elevation near 90°, and positive Neer and Hawkins test results).…”

Section: Surgical Techniquementioning

confidence: 99%

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Arthroscopic Excision for Painful Acromial Fracture Nonunion After Reverse Total Shoulder Replacement

Hartzler¹,

Ardebol

Denard

2022

Arthroscopy Techniques

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Section: Discussionmentioning

confidence: 99%

Section: Surgical Techniquementioning

confidence: 99%

Arthroscopic Excision for Painful Acromial Fracture Nonunion After Reverse Total Shoulder Replacement

Hartzler¹,

Ardebol

Denard

2022

Arthroscopy Techniques

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“…Once identified, a trial of sling immobilization and only passive shoulder ROM should be attempted for 6 weeks. If nonsurgical treatment is chosen, Boltuch et al 53 demonstrated that those fractures which occur at or are medial to the glenoid face are at high risk of a poor outcome. If symptoms persist with no evidence of healing on CT scans, then surgical treatment, consisting of an ORIF and/or conversion to a hemiarthroplasty, should be considered.…”

Section: Painful Etiologies Specific To a Reverse Total Shoulder Arth...mentioning

confidence: 99%

Evaluation of the Painful Total Shoulder Arthroplasty

Burrus

Werner

Menendez

et al. 2023

J Am Acad Orthop Surg

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Despite the overall success of anatomic and reverse total shoulder arthroplasties (aTSA and rTSA), some patients continue to have or develop pain postoperatively. As the number of shoulder arthroplasties continues to increase in the United States, it is important that surgeons are able to recognize, diagnose, and treat the various pathologies. Some painful etiologies are specific to either aTSA or rTSA, and others can occur with both implant types. Infections, stiffness, neurologic syndromes, polyethylene wear, aseptic implant loosening, and metal allergies occur, regardless of implant choice. However, after an aTSA, subscapularis repair failure, superior rotator cuff tear, and joint overstuffing can result in shoulder pain. After a rTSA, specific causes of postoperative pain include instability, scapular notching, acromial or scapular spine fractures, subcoracoid pain, and neurologic injury. Regardless of the diagnosis, the surgeon must be methodical in the evaluation and, when appropriate, use blood work, advanced imaging studies, joint aspirations, shoulder arthroscopy, and nerve studies. Once diagnosed, appropriate treatment should be undertaken to resolve the cause of the pain or at least minimize the effect of the pain on the patient's outcome.

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“…The landmark to denote the posteromedial edge of this region is the lateral extent of the acromial base. Type II fractures are subdivided into types IIa, IIb, and IIc based on positioning lateral to, directly behind, and medial to the glenoid, respectively 19 . A type III fracture includes the entire acromial base through the medial SS.…”

Section: Classification Systemsmentioning

confidence: 99%

Mitigating Fracture of the Acromion and Scapular Spine After Reverse Shoulder Arthroplasty

Buchanan,

Bindi,

Caban-Klepac

et al. 2023

JBJS Reviews

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» Biomechanical studies report that thin scapular spine (SS) morphology, superiorly placed glenoid components, and increased glenoid baseplate screws contribute to increased acromial and SS strain and may increase fracture risk. » Clinical risk factors of acromial and SS fractures after reverse shoulder arthroplasty include increasing age, female sex, osteoporosis, rheumatoid arthritis, thin midsubstance acromion morphology, previous acromioplasty, and surgical indication of cuff tear arthropathy. » Clinical studies show that, in isolation, excessive humeral lengthening, humeral lateralization, and glenoid medialization may increase risk of acromial and SS fractures. » Biomechanical studies suggest that a combination of glenoid medialization and humeral lateralization (MG/LH) may reduce fracture risk, although this requires clinical correlation. » Surgeons might reduce fracture risk in patients of high-risk groups by guarding against excessively lengthening the humerus, using a MG/LH prosthesis, and targeting screws to avoid the scapular notch and base of the SS. Level of Evidence: Level V. Narrative Review. See Instructions for Authors for a complete description of levels of evidence.

show abstract

Nonoperative treatment of acromial fractures following reverse shoulder arthroplasty: clinical and radiographic outcomes

Cited by 15 publications

References 20 publications

Arthroscopic Excision for Painful Acromial Fracture Nonunion After Reverse Total Shoulder Replacement

Arthroscopic Excision for Painful Acromial Fracture Nonunion After Reverse Total Shoulder Replacement

Evaluation of the Painful Total Shoulder Arthroplasty

Mitigating Fracture of the Acromion and Scapular Spine After Reverse Shoulder Arthroplasty

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