Is Acromial Fracture after Reverse Total Shoulder Arthroplasty a Negligible Complication?: A Systematic Review

Abstract

BackgroundThe purpose of this study was to investigate the incidence of acromial fracture after reverse total shoulder arthroplasty (RTSA) and clinical and radiological outcomes of treatment of the fracture.MethodsA systematic review was performed to identify studies that reported the results of treatment of acromial fractures after RTSA. A literature search was conducted by two investigators using four databases (PubMed, Embase, Cochrane, and Ovid Medline).ResultsFifteen studies (2,857 shoulders) satisfied our inclusion criteria. The incidence of acromial fracture after RTSA was 4.0% (114 / 2,857). The mean age of the patients at the time of fracture was 72.9 years (range, 51 to 91 years). The mean time from RTSA to diagnosis of acromial fracture was 9.4 months (range, 1 to 94 months). One hundred shoulders (87.7%) were treated conservatively and 14 shoulders (12.3%) were treated surgically. The mean follow-up period after acromial fracture was 33.8 months. The overall union rate was 50.0% (43.8% for conservative treatment and 87.5% for operative treatment). The fracture incidence was significantly different among the medial glenoid and medial humerus prosthesis design (8.4%), the lateral glenoid and medial humerus design (4.0%), and the medial glenoid and lateral humerus design (2.8%). The mean values at final follow-up were as follows: visual analog scale score, 2.2; American Shoulder and Elbow Surgeons score, 59.1; Constant score, 59.7; and Simple Shoulder Test, 5.8. The mean forward flexion, abduction, and external rotation were 102.3°, 92.3°, and 25.8°, respectively.ConclusionsAcromial fractures after RTSA are a complication neither uncommon nor negligible. In the absence of studies with high-level evidence, there is a controversy on the outcomes after treatment. Further well-designed prospective randomized controlled studies with a long-term follow-up should be performed to ascertain the diagnosis, treatment, and prognosis of acromial fractures after RTSA.

Causes of acromion and scapular spine fractures following reverse shoulder arthroplasty: a retrospective analysis and literature review

“…Because this ligament is routinely detached during a superolateral approach, one would expect a higher incidence of scapular spine fractures after a superolateral than after a deltopectoral approach. The review of Cho et al, however, showed that the opposite is the case [37].…”

“…This is obviously not the case. Most reported fractures appear within the first year after surgery [22,26,28,37]. Neyton et al [28] described 13 scapular fractures that already occurred at a mean 3.3 months postoperatively and Dubrow et al [22] reported on 14 acromial fractures that occurred at an average of 5.1 months after RSA.…”

“…Fractures of the acromion and the scapular spine are uncommon in individuals with normal shoulders [ 35 , 36 ] or anatomic prostheses but are frequently encountered in patients with reverse shoulder prostheses. The fracture rate after RSA averages 4 to 5% [ 37 – 39 ] and ranges from 0.5% [ 40 ] to 25% [ 21 ]. In our series, it attained 5.8%, which is higher than the 4.3% reported in another study with an onlay design prosthesis [ 26 ] but still within the range of other series.…”

Is Surgery Better Than Conservative Treatment for Proximal Humeral Fracture: A Systematic Review and Meta-Analysis

“…However, RSA is not a panacea, and it has its own limitations. For example, Cho CH [31] believed that we should pay great attention to the complications of acromion fractures that commonly occur after surgery. Since RSA is limited by glenoid loosening and instability, prosthesis implantation failure may occur, Song IS et al [32] believed that hemiarthroplasty could better solve such problems, and postoperative follow-up score and joint range of motion were satisfactory.…”

Simultaneous bilateral acromial base fractures after staged reverse total shoulder arthroplasty: A case report

“…Bilateral reverse total shoulder arthroplasty (RTSA) is a proven treatment option for in cuff tear arthropathy (CTA), requiring bilateral arthroplasty[ 1 - 3 ]. Acromial and scapular spine fractures after RTSA are a well-known complication that may negatively impact long-term outcomes[ 4 - 6 ]. In patients undergoing bilateral RTSA, bilateral fractures of the acromion or scapular spine are very rare.…”