Acute Displaced Fracture of Lateral Acromion after Reverse Shoulder Arthroplasty: A Case Report and Surgical Technique

Abstract

Acromial fractures are well-documented complications subsequent to reverse shoulder arthroplasty (RSA), and most appear as stress fractures with no history of single trauma. To date, no study has reported the occurrence of acute displaced acromial fracture due to sudden strong deltoid contraction during heavy work. Displacement of the fracture results in a challenging surgery since it is difficult to obtain adequate fixation in thin and osteoporotic bones. We report a rare case of acute displaced acromial fracture after successful RSA treatment, using a novel technique of open reduction and internal fixation, applying two 4.5 mm cannulated screws and lateral clavicle precontoured plate.

Acromial and Scapular Spine Fractures following Reverse Total Shoulder Arthroplasty—A Systematic Review of Fixation Constructs and Techniques

“…One study was identified from review references of the identified articles [ 29 ]. In total, nine clinical studies with 18 acromion or scapular spine fractures met the inclusion and exclusion criteria and were included in this review [ 16 , 17 , 18 , 29 , 30 , 31 , 32 , 33 , 34 ]. A detailed flow diagram of the search results is provided under Figure 2 .…”

“…The majority of patients were female (83.3), the average age was 74.2 years (range, 63–83 years) and the mean follow-up was 13.4 months (range, 2–24 months). Time from RSA to fracture fixation was not reported in two case reports [ 16 , 29 ]. These cases underwent fixation with a lateral locking plate with two lag screws and a 1/3 tubular plate, respectively ( Table 2 ).…”

“…Within the identified cohort of 18 fractures, one was classified as a Levy Type I fracture [ 16 ], 10 were Levy Type II fractures [ 17 , 30 , 31 , 32 , 33 ], and the remaining 7 fractures were defined as Levy Type III [ 18 , 29 , 34 ]. Fractures were classified according to Levy et al in two studies (four fractures) [ 13 , 17 , 19 , 34 ], with Levy classification ascertained by the authors for the other seven studies.…”

“…Four patients underwent fixation using a single lateral clavicle locking plate [ 16 , 30 , 34 ] (Acumed, Hillsboro, OR, USA). Three patients were treated with a cruciform pilon locking plate (Depuy Synthes, Oberdorf, Switzerland) [ 17 ].…”

“…Thus fixation of acromial/scapular spine fractures following RSA is both complex and technically demanding [ 15 ]. The literature contains an assortment of proposed fixation constructs varying in both the mode of fixation, such as plate fixation vs. tension band, as well as the individual fixation construct, such as number of plates, and use of specified plates (e.g., locking plates) [ 7 , 16 , 17 ]. The evidence on fixation technique specific outcomes is poor, making the declaration of a gold standard treatment difficult.…”