Shoulder function introduction modern reverse shoulder arthroplasty rsa methods, which have been developed based on the concept by grammont and baulot 1, are used to treat an increasingly broader spectrum of indications 2. Since the coracoid process is important as a stabilizer for many shoulder movements, surgical management may be necessary for displaced fractures to avoid a painful nonunion 2 practical points. Acromion fractures of the scapula are rare and most often occur with concomitant fractures of the ipsilateral glenoid, neck and body of the scapula as sequelae of highenergy injuries. Glenoid neck constitute about 25% fractures of the glenoid cavity glenoid rim and fossa make up approximately 10% of scapula fractures. The spectrum of the pathology can range from a stress reaction to an undisplaced or displaced fracture. This is often more clearly seen on a ct scan but ct scanning is not required if the fragment is. The distal pull of the deltoid muscle results in distal displacement of the acromion after fracture, and impingement of the suprascapular nerve may occur. Scapular fractures are generally classified as stable extraarticular, unstable extraarticular.
The fractures under type 1 are subdivided into type 1a and type 2b. The acromion process is attached to the scapular spine, and it works with the coracoid process of the. Acromion fractures may occur with glenoid process, scapula or clavicle distal fractures and disruption of superior shoulder suspensory complex 3. Clavicle fractures or ac joint injuries can create dyskinesis by disruption of the anatomy and biomechanics of normal scapular motion. Acromion of scapula, acromion types and acromion fracture. Surgical management of isolated acromion fractures. Surgical management of isolated acromion fractures request pdf.
Scapular body 50% to 60% of patients scapular neck 25% of patients glenoid acromion coracoid symptoms the most common symptoms of a scapula fracture include. Type ii distal clavicle fractures, which involve displacement, are associated with the highest incidence of nonunion. Historically, only unstable distal clavicle fractures were treated operatively. Your collarbone, arm bones, lungs, or chest may also be affected. Scapular neck fractures angulated beyond 40 degrees or displaced by 4. Limited guidance exists on the treatment of these fractures. Isolated displaced fracture of the acromion archives of trauma. Pdf we studied 37 fractures lateral to the spinoglenoidal notch to. In patients with polytrauma, diagnosis and treatment of acromion fractures can be delayed or overlooked 5. Ct, fracture, radiography, scapula, shoulder, trauma. Perform fluid resuscitation, stabilize the cardiopulmonary system, and treat lifethreatening injuries. A 39yearold patient, manual laborer, with a stress fracture at the base of the acromion that required surgical treatment due to persistent symptoms and. Isolated acromial fractures are uncommon, accounting for only 8% of scapular fractures. The management of scapular fractures has changed based on greater understanding of the injury, peri scapular anatomy, surgical approaches, and fracture fixation strategies.
Fractures of the acromion process that cause the arm bone to hit against it impingement syndrome during this operation, the bone fragments are first repositioned reduced in their normal alignment, and then held together by attaching metal plates with special screws to the outer surface of the bone. In certain cases, surgery to repair a broken scapula is necessary. The literature provides limited data on the risk factors associated with this complication as well as the ultimate outcomes after nonoperative treatment. Scapular fracture rarely do require open reduction, and operative treatment is indicated when they are displaced glenoid intraarticular and. The angle of the bone causes a deformity in the limb angular deformity 3 the bone positioning is no longer in its correct, anatomical position displacement 3 the glenoid socket is fractured, causing instability of the ball and socket joint. Management of distal clavicle fractures abstract most clavicle fractures heal without difficulty. Health library sports injuries general information. The combination of a thin acromion and superior migration of the humeral head increase the risk of acromial fracture. The coracoid process plays a pivotal role in the foundation of the coracoacromial arch and in cases of displaced fractures. However, recent wellconducted studies demonstrate that plate fixation of displaced midshaft clavicle fractures may result in improved functional outcome and a lower rate of malunion and. Mr darren p forward, queens medical centre, nottingham.
In ac joint injuries, the loss of the suspension of the scapula on the clavicle, unbalanced muscle pull, and gravity produce the dyskinetic protraction 32. Treatment of acromion and scapular spine fractures after reverse shoulder arthroplasty depends on the fracture location, displacement, and. Coracoid process fracture radiology reference article. Intraoperative fractures are rare and may be treated conservatively or with acute fixation depending on location and displacement of the fracture as well as implant stability. Fracture of the acromion associated with arterial lesion. A fracture of this bone is termed as a scapula or broken shoulder blade. Burkhead, md, stuart gordon, md, john racanelli, md, and louis ruland, md, baltimore, md. A complication of arthroscopic subacromial decompression leslie s.
Acromion fracture and lateral angle of the scapula spine. A fibrous capsule surrounds the joint and there may be a. Traumatic acromion fractures are rare and typically occur in patients with multiple fractures, which often delays diagnosis. Shoulder trauma fractures and dislocations trauma to the shoulder is common. Acromial and scapular spine fractures after reverse total.
Acromial fractures and scapular spine fractures may occur intraoperatively or postoperatively in association with rsa. Pdf fractures of the acromion and the lateral scapular spine. From the lateral border of acromion, originate the fibers of middle deltoid. A scapular fracture is a break in your shoulder blade scapula. Concurrent injuries to the chest rib fractures, contusions, pneumothorax or peripheral nerves or nerve roots are commonly observed, so careful evaluation of the patient, including chest radiographs and neurological examination, is important.
Acromial fractures in reverse shoulder arthroplasty. Acromion fractures impinging on the rotator cuff in the sub acromial 4. Material and methods all patients were treated in bellland general hospital. Table 1 rates of acromial and scapular spine fractures in patients undergoing reverse shoulder arthroplasties in the literature author year patient number. With the exception of displaced articular glenoid fractures, management of scapular fractures has largely consisted of benign neglect, with an emphasis on motion as allowed by the patients pain. Better understanding of this injury has resulted in greater acceptance of surgical management of highly displaced variants. We present a case of a fracture at the base of the acromion 5. Knowledge of scapular anatomy, function, injury patterns, imaging appearance, and clinical management is important for the radiologist to the care of patients who present with acute shoulder trauma. The reported mortality rate of patients with scapular fractures from the concomitant injuries varies between 2% and 15%. Fractures of the acromion process or, more commonly, osteotomy of the acromion needed to expose the scapular neck and shoulder joint, require surgical repair. Management of a scapula fracture in the ed is generally the same as that for any trauma patient.
Acromion fractures may occur as a result of shoulder trauma and overuse injuries. Most scapular fractures occur secondary to vehicular trauma. Risk factors can be classified into surgical indication, patient comorbidities, acromial pathology, and surgical technique. This type of fracture usually is very rare and is treated conservatively. Most of these fractures have been associated with concomitant skeletal and soft tissue injuries of the shoulder 2, 3. Fractures around the acromion are a known complication of reverse total shoulder arthroplasty. The acromial and coracoid processes account for 8% and 7%, respectively. Anatomical reconstruction to treat acromion fractures. Acromion is the lateral projection of the spine of scapula and fracture of this bone is a rare orthopedic condition as it accounts for only 8% of all scapular fractures. Treatment includes pain management, shortterm use of a sling for comfort, and physical therapy as needed. Approximately 50% of scapula fractures involve the body and spine. Indications for operative management include symptomatic nonunion, displaced fractures. Scapular fracture aftercare instructions what you need. The scapula has a substantial protective soft tissue envelope and considerable trauma is required to fracture it.
Clavicle and scapular fractures intermountainphysician. Request pdf surgical management of isolated acromion fractures acromion fractures of the scapula are rare and most often occur with concomitant fractures. Definitiona complete or incomplete break of the acromion the part of the shoulder blade that projects over the shoulder joint and forms the highest point of the shoulder. Concomitant fractures of the acromion, coracoid, and. In summary, postoperative acromial stress fractures appear to be incidental lesions with little influence on the outcome after rsa. A direct approach through langers lines allows for easy exposure and direct visuali. Fractures of the scapula occur very infrequently in small animal patients. Shoulder injuries from trauma scapula nonunion hope tbi. Coracoid fractures represent fractures and 2% of scapular fractures 1 treatment and prognosis.
Fractures are classified as type 1, type 2, type 3, and stress fractures. We recommend early surgical treatment for displaced acromion fractures, reduction of subacromial space and disruption of the superior shoulder suspensory. Rare acromial nonunion that was managed conservatively with. Rehabilitation guidelines for proximal humerus fracture nonoperative 2 p a g e phase ii continued precautions dc sling x 3 weeks if cleared by md aarom to 90 degrees forward flexion and 40 degrees er suggested therapeutic exercises arom cervical, elbow, wrist and hand pendelums gripping exercises scapular pnf. The joint acts a strut for the shoulder and allows for the arm to be. However, radiographic nonunion after distal clavicle fracture has been reported in 10% to 44% of patients. Successful treatment of fractures of the base of the acromion after. The emphasis of this article is on the management of these injuries. Additionally, there are three fracture or not, moreno will miss at least the next four weeks the ac joint is located when the collarbone connects to the shoulder blade at a bony proves known as the acromion. Fractures of the scapula acta chirurgiae orthopaedicae et. They are often associated with rotator cuff injury and impairment of shoulder function. Injuries range from a separated shoulder resulting from a fall onto the shoulder to a highspeed car accident that fractures the shoulder blade scapula or collarbone clavicle. Conservative management of acromial stress fractures resulted in a small loss of motion compared with what had been achieved before fracture, but clinical outcome scores ases, sane, vas were not. Acromial and scapular spine fractures after reverse total shoulder arthroplasty occur predominantly as a result of bony insufficiency secondary to patient and intraoperative technical factors.
Acute shoulder injuries in adults american academy of. Consequence of treatment by open reduction and pin fixation. Stress fracture of base of the acromion annals of the. Posterior positioning of a clavicle hook plate is a risk. An acromial fracture should be part of a differential diagnosis of traumatic shoulder pain. Fractures of the acromion and scapula are known to occur after reverse shoulder arthroplasty. Acromial fractures constitute 9% of fractures of the scapula, which amounts to 35% of shoulder girdle injuries. Fractures of the scapula occur infrequently, with a fracture of the acromion being an even rarer entity. Review article management of distal clavicle fractures. However, little agreement exists on indications for.
Stress fractures of the base of the acromion are rare and tend to progress well when conservatively treated. There are no common accepted treatment schemes and fixation methods for acromion fractures 4. We investigated a selection of parameters, including rockwood classification, hook angle, the degree of reduction, and the coverage of the hook under the acromion to identify risk factors for acromial fractures. Surgery for a scapular fracture may be recommended when. Evaluation and management of scapular dyskinesis in. In patients with polytrauma, diagnosis and treatment of acromion fractures. Indications for operative management include symptomatic nonunion, displaced fractures, or acromion fractures associated with other lesions of the superior shoulder suspensory complex. Shoulder trauma fractures and dislocations orthoinfo. The scapula or the shoulder blade is a triangle shaped bone which is surrounded by a complicated web of muscles. The need for surgery due to this type of fracture has only been reported in two case reports. The authors report a rare case of fracture of the acromion associated with injury of the ipsilateral ulnar artery and describe its treatment, as well as pre and. With the exception of displaced articular glenoid fractures, management of scapular fractures has largely consisted of benign neglect, with an emphasis on motion as.
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