Os acromiale: a review of its incidence, pathophysiology, and clinical management

Abstract

An os acromiale occurs when any of the primary ossification centres of the acromion fail to fuse with the basi-acromion. It is present in approximately 8% of individuals, and whilst the majority of these individuals are unaffected it can cause significant pain and disability. It can impact seemingly unrelated surgical intervention in the region such as subacromial decompression and reverse shoulder arthroplasty. A painful os acromiale can be both a diagnostic challenge, and difficult to manage. There remain a wide variety of surgical practices with variable outcomes achieved. We present an evidence-based discussion of the surgical techniques described to date in the literature, alongside a comprehensive review of the incidence and pathophysiology of os acromiale. This review was written after a comprehensive analysis of the literature to date relating to os acromiale. Particular focus was given to material examining surgical management techniques, and the condition’s incidence across different population groups. Open reduction and internal fixation using cannulated screws, or tension band wiring have superior outcomes in the literature in the treatment of symptomatic os acromiale. There may be a biomechanical advantage of combining the two techniques. Preservation of large anterior deltoid attachment is necessary, with consideration being given to the local blood supply. There is likely no additional benefit from iliac crest vs local bone grafting. Research in this area remains of a low evidence level with small samples sizes. Appropriately powered clinical research of a higher-level evidence methodology is needed in order to differentiate further in the choice of surgical intervention. Cite this article: EFORT Open Rev 2019;4:525-532. DOI: 10.1302/2058-5241.4.180100

Comparison of Anterior and Posterior Decompressions in Treatment of Traumatic Thoracolumbar Spinal Fractures Complicated with Spinal Cord Injury

“…Moreover, during anterior decompression, bone fragments in the spinal canal can be completely removed under direct vision [ 18 ], effectively alleviating spinal cord compression and avoiding the iatrogenic damage to the spinal cord caused by distraction during posterior decompression [ 19 ]. Anterior decompression the advantages of clear exposure during surgery, accurate decompression effect, small trauma, and fast fusion of factured vertebrae after surgery [ 20 ]. Compared with other similar research [ 7 , 11 , 15 ], the novelty of our study is that we showed anterior decompression effectually enhances the surgical outcomes, restores the physiological anatomy of fractured vertebrae, improves the postoperative nerve functions, and accelerates the recovery of urinary and sexual functions in patients with thoracolumbar spinal fractures complicated with spinal cord injury, which can improve their quality of life.…”

Imaging of the Acromioclavicular Joint: Anatomy, Function, Pathologic Features, and Treatment

“…The most common type of os acromionale is related to failed fusion between the mesoacromion and meta-acromion, resulting in a coronal cleft at the posterior margin of the AC joint (10,99,100). The majority of cases are asymptomatic, although some of these disorders cause pain related to an unstable synchondrosis or an impingementlike syndrome during overhead activity (101). If symptoms do not respond to conservative measures, surgical options include screw fixation of the synchondrosis or resection (13,100).…”

Acromion types and morphometric evaluation of painful shoulders

“…It is usually detected incidentally in radiology; however, os acromiale can lead symptoms in some cases [12]. Both the diagnosis and treatment of a painful os acromiale is difficult [9].…”