Postoperative results of Ogawa type IIB meta-acromion fracture fixation with a 90° twisted reconstruction plate

Ipsilateral fractures of the acromion and coracoid processes of the scapula

A fracture of the acromion and coracoid processes of scapula is rarely seen in the outpatient clinic, due to the acromion's anatomical position and shape, as well as the strong ligaments and muscles that are attached to it. These fractures are caused by either direct or indirect high-energy trauma injuries to the shoulder joint, leading to severe pain and a grossly restricted range of motion. Several acromial classifications were reported, but this type of longitudinal plane fracture of the acromion process in our case is yet to be described in the current literature. We present a rare combination of the coracoid process and unstable acromion bony projection fractures that have not previously been noted for this type of fracture. The closest to this is Kuhn's type III classification. A 51-year-old male presented to our emergency department complaining of the right shoulder pain and difficulty raising his arm following a 2-wheeler accident. The patient was managed by open reduction and internal fixation with 3 cannulated cancellous screws fixation and progressed well with no postoperative complications. He was asymptomatic postoperatively and regained full range of motion after 4 months.

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

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.

Octogenarian With Acromion Stress Fracture Nonunion With Reverse Total Shoulder Prosthesis Reconstructed With Plates and Screws: A Case Report

An 85-year-old male underwent open reduction and internal fixation (ORIF) for a displaced acromion stress fracture that occurred two years prior. The complete fracture occurred two months after an ipsilateral reverse total shoulder arthroplasty (RTSA). Four weeks after his RTSA, the pain was felt at the posterior-superior shoulder with activities of his daily living as a rancher, reflecting non-compliant use. A stress fracture was suspected but not detected radiographically. Four weeks later, higher pain occurred after he lifted a hay bale, and a displaced basilar acromion fracture was detected. Non-operative management spanned 20 months, which he ultimately deemed unacceptable because of pain with minor activities. ORIF was then done. Approximately 10 months after the ORIF surgery, both plates sustained fatigue breakage; however, the fracture consolidated, and his pain remained low. He is the oldest patient described to ultimately have a successful acromion fracture ORIF and only the third reported acromion fracture ORIF in octogenarians following RTSA. We report the ORIF technique, its good outcome, and a literature review of elderly patients who had ORIF for this problem.

The study of screw placement parameters for Ogawa type I acromial fractures by 3D simulation

Background

Acromial fractures are rare and there is no consensus on fixation, but an increasing number of studies have reported using two screws to fix Ogawa type I acromial fractures. The objective of this study was to obtain the ideal length, diameter, insertion point, and angle of the screw using a novel 3D simulation.

Methods

The scapular CT data of 100 individuals were obtained to reconstruct 3D models. The transparency of the 3D model was then downgraded along the axial perspective (the view perpendicular to the cross section of the acromion axis) to find the maximum translucent area. Two virtual screws were placed at the anterior edge of the acromion until they penetrated the posterior cortical bon. The largest diameters and lengths of the screw were measured, and the direction and insertion point of the screw were observed.

Results

The mean maximum lengths of the medial and lateral screws were 43.33 ± 6.17 mm and 39.23 ± 6.01 mm, respectively. The mean maximum diameters of the medial and lateral screws were 4.71 ± 1.23 mm and 4.97 ± 1.07 mm, respectively. Differences in screw length, diameter, and insertion point between males and females were found. The differences in screw angle between sexes were not statistically significant.

Conclusions

Based on a 3D model test, we recommend the size, entry points, and angles of screws for Ogawa type I acromial fractures, providing valuable guidance for clinical work. More accurate screw parameters can be obtained preoperatively by establishing an individualized 3D model.