A fibrous capsule surrounds the joint and there may be a. Pdf we studied 37 fractures lateral to the spinoglenoidal notch to. A scapular fracture is a break in your shoulder blade scapula. 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. Successful treatment of fractures of the base of the acromion after. Acromial fractures constitute 9% of fractures of the scapula, which amounts to 35% of shoulder girdle injuries. 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. 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. Review article management of distal clavicle fractures.
Pdf fractures of the acromion and the lateral scapular spine. A complication of arthroscopic subacromial decompression leslie s. Fractures of the acromion process or, more commonly, osteotomy of the acromion needed to expose the scapular neck and shoulder joint, require surgical repair. 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. 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. Perform fluid resuscitation, stabilize the cardiopulmonary system, and treat lifethreatening injuries.
Acromion fractures impinging on the rotator cuff in the sub acromial 4. Anatomical reconstruction to treat acromion fractures. Shoulder trauma fractures and dislocations trauma to the shoulder is common. The reported mortality rate of patients with scapular fractures from the concomitant injuries varies between 2% and 15%. Mr darren p forward, queens medical centre, nottingham. Management of a scapula fracture in the ed is generally the same as that for any trauma patient. Fractures of the scapula acta chirurgiae orthopaedicae et. A direct approach through langers lines allows for easy exposure and direct visuali. With the exception of displaced articular glenoid fractures, management of scapular fractures has largely consisted of benign neglect, with an emphasis on motion as. Clavicle fractures or ac joint injuries can create dyskinesis by disruption of the anatomy and biomechanics of normal scapular motion. Isolated acromial fractures are uncommon, accounting for only 8% of scapular fractures. Acromial fractures and scapular spine fractures may occur intraoperatively or postoperatively in association with rsa. Acromial fractures in reverse shoulder arthroplasty.
Treatment of acromion and scapular spine fractures after reverse shoulder arthroplasty depends on the fracture location, displacement, and. The combination of a thin acromion and superior migration of the humeral head increase the risk of acromial fracture. 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. Evaluation and management of scapular dyskinesis in.
Most scapular fractures occur secondary to vehicular trauma. Scapular fractures are generally classified as stable extraarticular, unstable extraarticular. 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. The coracoid process plays a pivotal role in the foundation of the coracoacromial arch and in cases of displaced fractures. The scapula has a substantial protective soft tissue envelope and considerable trauma is required to fracture it. Indications for operative management include symptomatic nonunion, displaced fractures, or acromion fractures associated with other lesions of the superior shoulder suspensory complex.
Request pdf surgical management of isolated acromion fractures acromion fractures of the scapula are rare and most often occur with concomitant fractures. We present a case of a fracture at the base of the acromion 5. Table 1 rates of acromial and scapular spine fractures in patients undergoing reverse shoulder arthroplasties in the literature author year patient number. 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. They are often associated with rotator cuff injury and impairment of shoulder function. Shoulder trauma fractures and dislocations orthoinfo.
We recommend early surgical treatment for displaced acromion fractures, reduction of subacromial space and disruption of the superior shoulder suspensory. 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. Acute shoulder injuries in adults american academy of. An acromial fracture should be part of a differential diagnosis of traumatic shoulder pain. 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. 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. 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.
In certain cases, surgery to repair a broken scapula is necessary. Surgical management of isolated acromion fractures request pdf. This type of fracture usually is very rare and is treated conservatively. The joint acts a strut for the shoulder and allows for the arm to be. The distal pull of the deltoid muscle results in distal displacement of the acromion after fracture, and impingement of the suprascapular nerve may occur. Rare acromial nonunion that was managed conservatively with. However, little agreement exists on indications for. However, radiographic nonunion after distal clavicle fracture has been reported in 10% to 44% of patients. Glenoid neck constitute about 25% fractures of the glenoid cavity glenoid rim and fossa make up approximately 10% of scapula fractures. Your collarbone, arm bones, lungs, or chest may also be affected. 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.
The spectrum of the pathology can range from a stress reaction to an undisplaced or displaced fracture. Isolated displaced fracture of the acromion archives of trauma. A 39yearold patient, manual laborer, with a stress fracture at the base of the acromion that required surgical treatment due to persistent symptoms and. Scapular fracture aftercare instructions what you need.
Consequence of treatment by open reduction and pin fixation. Health library sports injuries general information. 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. Most of these fractures have been associated with concomitant skeletal and soft tissue injuries of the shoulder 2, 3.
There are no common accepted treatment schemes and fixation methods for acromion fractures 4. Burkhead, md, stuart gordon, md, john racanelli, md, and louis ruland, md, baltimore, md. Scapular fracture rarely do require open reduction, and operative treatment is indicated when they are displaced glenoid intraarticular and. In patients with polytrauma, diagnosis and treatment of acromion 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. Material and methods all patients were treated in bellland general hospital. Posterior positioning of a clavicle hook plate is a risk. Management of distal clavicle fractures abstract most clavicle fractures heal without difficulty. In summary, postoperative acromial stress fractures appear to be incidental lesions with little influence on the outcome after rsa. 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. Acromion of scapula, acromion types and acromion fracture. Clavicle and scapular fractures intermountainphysician. 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. Shoulder injuries from trauma scapula nonunion hope tbi. Ct, fracture, radiography, scapula, shoulder, trauma. Acromial and scapular spine fractures after reverse total.
The scapula or the shoulder blade is a triangle shaped bone which is surrounded by a complicated web of muscles. The management of scapular fractures has changed based on greater understanding of the injury, peri scapular anatomy, surgical approaches, and fracture fixation strategies. Fractures are classified as type 1, type 2, type 3, and stress fractures. 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. Risk factors can be classified into surgical indication, patient comorbidities, acromial pathology, and surgical technique. From the lateral border of acromion, originate the fibers of middle deltoid.
Coracoid fractures represent fractures and 2% of scapular fractures 1 treatment and prognosis. The emphasis of this article is on the management of these injuries. Concomitant fractures of the acromion, coracoid, 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. Stress fracture of base of the acromion annals of the. Coracoid process fracture radiology reference article. Surgery for a scapular fracture may be recommended when. Surgical management of isolated acromion fractures. 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. 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. A fracture of this bone is termed as a scapula or broken shoulder blade. Stress fractures of the base of the acromion are rare and tend to progress well when conservatively treated. The fractures under type 1 are subdivided into type 1a and type 2b. Limited guidance exists on the treatment of these fractures.
The acromion process is attached to the scapular spine, and it works with the coracoid process of the. Fractures of the scapula occur infrequently, with a fracture of the acromion being an even rarer entity. Treatment includes pain management, shortterm use of a sling for comfort, and physical therapy as needed. Scapular neck fractures angulated beyond 40 degrees or displaced by 4. Approximately 50% of scapula fractures involve the body and spine. Historically, only unstable distal clavicle fractures were treated operatively. This is often more clearly seen on a ct scan but ct scanning is not required if the fragment is. Better understanding of this injury has resulted in greater acceptance of surgical management of highly displaced variants. Fracture of the acromion associated with arterial lesion. Acromion fracture and lateral angle of the scapula spine. Fractures around the acromion are a known complication of reverse total shoulder arthroplasty. Acromion fractures may occur with glenoid process, scapula or clavicle distal fractures and disruption of superior shoulder suspensory complex 3. Traumatic acromion fractures are rare and typically occur in patients with multiple fractures, which often delays diagnosis. The need for surgery due to this type of fracture has only been reported in two case reports.
In patients with polytrauma, diagnosis and treatment of acromion fractures can be delayed or overlooked 5. The acromial and coracoid processes account for 8% and 7%, respectively. Acromion fractures may occur as a result of shoulder trauma and overuse injuries. Fractures of the acromion and scapula are known to occur after reverse shoulder arthroplasty.
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