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International Journal of Surgery Case... 2019Scapular fractures are uncommon and correspond to 0.5-1% of all body fractures. The study objective was to present a rare case report of a fracture (lateral acromion and...
INTRODUCTION
Scapular fractures are uncommon and correspond to 0.5-1% of all body fractures. The study objective was to present a rare case report of a fracture (lateral acromion and angle of the scapula spine) and review of the literature on which will greatly contribute to diagnosis and treatment.
PRESENTATION OF CASE
A 74-year-old female patient with comminuted fracture of the acromial process and lateral angle of the spine of the scapula with subacromial space. The patient underwent surgical treatment with open reduction and use of blocked plaque, two plain Steinmann wires 2.0 and local bone graft.
DISCUSSION
Segmental fracture of acromion and spine of the scapula needs early diagnosis for the proper treatment. In our case report, the patient presented fracture of the acromion and lateral angle of the spine of the scapula, classified as Ogawa 1 and 3; Kunt 3; and AO A1, respectively.
CONCLUSION
Segmental fracture of the acromion and lateral angle of the spine of the scapula with subacromial space reduction requires surgical intervention in order to avoid secondary complications. Early diagnosis favors better prognosis.
PubMed: 31284224
DOI: 10.1016/j.ijscr.2019.06.036 -
The Journal of the American Academy of... Mar 2022With the increased use of reverse shoulder arthroplasty, the complication of postoperative scapular fracture is increasingly recognized. The incidence is variable and...
With the increased use of reverse shoulder arthroplasty, the complication of postoperative scapular fracture is increasingly recognized. The incidence is variable and dependent on a combination of factors including patient age, sex, bone mineral density, diagnosis of inflammatory arthritis, acromial thickness, and implant-related factors. Acromial stress reactions are a clinical diagnosis based on a history and physical examination. These are treated successfully with 4 to 6 weeks of immobilization. Acromial stress fractures are visible on imaging studies and are classified based on anatomic location by the classification systems of Crosby and Levy. In approximately 20% of fractures, a CT scan is necessary to make the diagnosis. Treatment is typically nonsurgical that leads to a high rate of nonunion or symptomatic malunion. Scapular spine fractures (type III) can be treated with either nonsurgical or surgical management; however, obtaining fracture union is challenging, and the outcomes are typically inferior to that of type I and II fractures. Although the nonsurgical and surgical treatment of acromial stress fractures improves the clinical outcomes from the patient's preoperative state, the outcomes of a control group undergoing reverse shoulder arthroplasty without fracture are better. The exception to this is oftentimes the displaced and angulated type III fracture.
Topics: Acromion; Arthroplasty, Replacement, Shoulder; Fractures, Bone; Humans; Retrospective Studies; Shoulder Fractures; Shoulder Joint; Treatment Outcome
PubMed: 35050935
DOI: 10.5435/JAAOS-D-20-01205 -
Journal of Shoulder and Elbow Surgery Jun 2023Acromion and scapular spine stress fractures can be catastrophic complications following reverse shoulder arthroplasty (RSA). A variety of host, implant, and technical...
INTRODUCTION
Acromion and scapular spine stress fractures can be catastrophic complications following reverse shoulder arthroplasty (RSA). A variety of host, implant, and technical factors have been identified that increase the risk of this complication. The glenoid component in particular has been closely evaluated for its impact on rates of stress fractures following RSA. The goal of this biomechanical study is to evaluate if humeral stem version has an impact on acromion and scapular spine strain after RSA.
METHODS
Eight cadaveric specimens were tested on a custom dynamic shoulder frame. Commercially available RSA components were implanted with the humeral component inserted in 0° of retroversion. Acromion and scapular spine strain were measured at 0°, 30°, and 60° of abduction using strain rosettes secured to the acromion and scapular spine in the typical locations for Levy type II and type III stress fractures, respectively. The humeral stem was then removed and reimplanted in 30° of retroversion and the measurements were repeated. Student t test was performed to analyze the relationship between humeral stem version and acromion and scapular spine strain at various abduction angles.
RESULTS
Strain at the both the acromion and scapular spine were found to have no significant difference at any abduction angle when comparing 0° and 30° version of the humeral stem. With 0° and 30° versions pooled together, there is significantly lower acromion and scapular spine strain at 60° of abduction when compared to 0° of abduction (strain at 0° abduction - strain at 60° abduction: acromion 313.1 μꜪ; P = .0409, Scapular spine 304.9 μꜪ; P = .0407). There was no significant difference in strain at either location when comparing 0° of abduction to 30° of abduction and when comparing 30° of abduction to 60° of abduction.
CONCLUSIONS
This biomechanical study found no significant difference in scapular spine and acromion strain after RSA when comparing variations in humeral stem version. There does appear to be lower strain at both the acromion and scapular spine at 60° of abduction when compared to 0° of abduction regardless of stem version.
Topics: Humans; Acromion; Arthroplasty, Replacement, Shoulder; Fractures, Stress; Shoulder Joint; Range of Motion, Articular; Humerus
PubMed: 36828287
DOI: 10.1016/j.jse.2023.02.012 -
Clinical Anatomy (New York, N.Y.) Jan 2019The causes of degenerative rotator cuff (RTC) tears are unclear but certain acromion morphology may contribute. This study's objective was to determine using a... (Meta-Analysis)
Meta-Analysis
The causes of degenerative rotator cuff (RTC) tears are unclear but certain acromion morphology may contribute. This study's objective was to determine using a systematic review and meta-analysis the association of acromion type and acromial index with the prevalence of RTC tears. Six databases were searched electronically. Seventeen relevant studies between 1993 and 2017 were included in the meta-analyses determining the association of RTC tears with acromion type (n = 11) or acromial index (n = 10). Effect sizes were calculated as an odds ratio (OR) for the studies reporting acromion type and as raw mean difference (RMD) for the studies reporting acromial index. Meta-analysis was performed using a random-effects model. There was a significant small-to-medium effect found in the meta-analysis for acromion type (overall OR = 2.82, P = 0.000003), indicating an almost three times greater odds for a RTC tear in individuals with a type-III acromion as compared with those with a type-I or -II. A significant effect was also found for acromial index (RMD = 0.071, P < 0.0000001), indicating that a larger acromial index is associated with a greater likelihood of a RTC tear. Because of substantial heterogeneity in RMD for acromial index (Q-df = 92, P < 0.00001; I = 89%), subgroup analyses and meta-regressions were performed. Interestingly, the continent where the study was conducted (i.e., Europe vs. Asia) was the only moderator variable that could explain some of the acromial index heterogeneity. Overall, the findings from our analyses indicate that individuals with either a type-III acromion and/or a larger acromial index have a greater likelihood for non-traumatic RTC tears. Clin. Anat. 32:122-130, 2019. © 2018 Wiley Periodicals, Inc.
Topics: Acromion; Humans; Rotator Cuff Injuries
PubMed: 30362636
DOI: 10.1002/ca.23309 -
Arthroscopy : the Journal of... Dec 2022The treatment of an irreparable rotator cuff tear is an enigma. There are so many treatment options, with different experts recommending different treatments. These...
The treatment of an irreparable rotator cuff tear is an enigma. There are so many treatment options, with different experts recommending different treatments. These include physical therapy, partial repairs, tendon transfers such as the latissimus dorsi and the lower trapezius, biceps tenotomy, tissue augmentation with allografts or autografts, balloon spacers, and finally a reverse prosthesis. It is an easy decision when the patient is physiologically old with many medical comorbidities and arthritis. It is much more difficult when the patient is younger with no arthritis. Many patients with a failed massive cuff repair do well with a supervised therapy program despite the absence of 2 tendons (the supraspinatus and infraspinatus). Nothing works well when the subscapularis and/or teres minor are irreparable. I will usually try a 3-month physical therapy program, and if this is not successful in improving pain and function, consider surgery. If I can do an adequate partial repair, where the residual defect is small enough that the humeral head does not button hole through the defect like a boutonniere deformity, that is my treatment of choice. I will only do grafts with Hamada stage 1 or 2, as stage 3 with a fixed humeral head against the acromion do not do well. I am intrigued by the balloon spacer and why the results are still adequate, even when there is no balloon present after about 1 year. I'm holding judgment on that until there are more published studies. A reverse prosthesis I use as a last resort.
Topics: Humans; Rotator Cuff Injuries; Rotator Cuff; Acromion; Humeral Head; Superficial Back Muscles; Arthritis
PubMed: 36462777
DOI: 10.1016/j.arthro.2022.07.013 -
Der Orthopade Feb 2018An irreparable cuff tear is defined as the inability to achieve direct repair of native tendon to the great tuberosity despite intra- and extra-articular release of the... (Review)
Review
An irreparable cuff tear is defined as the inability to achieve direct repair of native tendon to the great tuberosity despite intra- and extra-articular release of the remaining tissue. Three distinct anatomic patterns are identified: posterosuperior cuff tears which involve the supraspinatus, infraspinatus and teres minor; anterosuperior tears which involve the supraspinatus and subscapularis; and global tears which comprise both. Subacromial debridement and tenotomy or tenodesis of the long head of the biceps are proposed for older patients with a functional but very painful shoulder. Partial repair-particularly the infraspinatus and the subscapularis-is indicated for young patients if the muscle is still trophic with a fatty infiltration less than 3. It can be combined with a tendon transfer. In irreparable posterosuperior tears, latissimus dorsi or lower trapezius transfer has been reported to improve active elevation and external rotation. In anterosuperior cuff tears, pectoralis major or latissimus transfer has been used. If the lack of external rotation is isolated with good active forward elevation, the L'Episcopo procedure is the procedure of choice. New techniques with a short follow-up have been proposed recently: implantation of a balloon-shaped, biodegradable spacer in the subacromial space to maintain the position of the humeral head and to facilitate deltoid action; capsular superior reconstruction with a fascia lata or an artificial graft implanted between the superior glenoid rim and the great tuberosity to reproduce the natural capsule of the supra- and infraspinatus and to stabilize the humeral head.
Topics: Acromion; Adult; Age Factors; Aged; Arthrography; Arthroscopy; Biomechanical Phenomena; Debridement; Equipment Design; Female; Humans; Male; Middle Aged; Muscles; Organ Sparing Treatments; Prostheses and Implants; Rotator Cuff Injuries; Shoulder Joint; Tendon Transfer; Tenodesis; Tenotomy; Tomography, X-Ray Computed
PubMed: 29380001
DOI: 10.1007/s00132-017-3516-1 -
Orthopaedics & Traumatology, Surgery &... Jun 2021Acromioplasty is controversial. Technically, it consists in bone resection, but there is no gold-standard technique and resection is often not quantified. The aims of... (Review)
Review
INTRODUCTION
Acromioplasty is controversial. Technically, it consists in bone resection, but there is no gold-standard technique and resection is often not quantified. The aims of the present study were 1/to assess the methodological quality of studies of acromioplasty; 2/to identify reports in which acromioplasty was quantified; and 3/to assess any correlation between clinical results and resection quantity.
MATERIAL AND METHODS
A systematic literature review was performed on PRISMA criteria in the PubMed, Springer and Ovid databases, including all articles in French or English referring to acromioplasty. Articles were analyzed by 2 surgeons and those with complete procedural description were selected. 1/Methodology was assessed on 3 grades according to aim of acromioplasty, intraoperative assessment of resection, and postoperative radiologic assessment. 2/Results were extracted from articles with robust methodology and quantitative data. 3/Correlations were assessed between clinical results and resection quantity.
RESULTS
Out of the 250 articles retrieved, 94 were selected. 1/44 of these (47%) specified the aim of the acromioplasty, 53 (56%) included an intraoperative clinical assessment criterion, and 13 (14%) included postoperative radiographic assessment. Methodologic quality was insufficient in 33 articles (35%), poor in 23 (24%) and robust in 38 (40%). 2/Seven articles (7.5%) included quantitative results. 3/Three articles assessed correlation between clinical results and resection quantity, but only 1 used reproducible radiographic assessment by critical shoulder angle (CSA); this study reported a significant positive correlation between clinical results and decreased CSA.
CONCLUSION
Methodology in studies of acromioplasty was largely insufficient and resection was usually not quantified. Current data to assess the usefulness of the procedure are sparse. We advocate including a Checklist for Acromioplasty Studies in the methodology of future studies. There is at present no gold-standard for assessing and quantifying acromial resection. CSA seems contributive, but other methods might be worth developing.
LEVEL OF EVIDENCE
IV; systematic review of level 1-4 studies.
Topics: Acromion; Arthroplasty; Arthroscopy; Humans; Rotator Cuff; Shoulder Joint
PubMed: 33771721
DOI: 10.1016/j.otsr.2021.102900 -
Arthroscopy : the Journal of... Mar 2022The critical shoulder angle (CSA) reflects the lateral extent of the acromion and the inclination of the glenoid. In 2013, CSA was first introduced and its association...
Editorial Commentary: Current Indications for Lateral Acromioplasty Include Patients With Elevated Critical Shoulder Angle Plus Subacromial Impingement With Rotator Cuff Pathology or Previous Rotator Cuff Repair.
The critical shoulder angle (CSA) reflects the lateral extent of the acromion and the inclination of the glenoid. In 2013, CSA was first introduced and its association with rotator cuff (RC) tears and glenohumeral osteoarthritis (GHOA) was shown. It was speculated that with a high CSA, there was an increased superior force vector from the deltoid and that this superior force led to RC tears. Conversely, when the CSA was low, there was a greater compressive force from the deltoid and that this compressive force led to GHOA. CSA serves as a further development of 2 previously reported measurements (glenoid inclination and acromial index). A key potential therapeutic aspect of the CSA is the ability to modify it surgically, which theoretically could protect RC repairs or prevent progression. In our current clinical practice, we perform lateral acromioplasty (LA) in patients undergoing treatment of subacromial impingement with an "at-risk" rotator cuff (partial rotator cuff tear and severe tendinopathy on magnetic resonance imaging) with a CSA > 38° or all patients with a CSA >35° after an RC repair to protect the RC repair construct. The relationships of high and low CSA, the anatomic safe zone, and thus clinical applicability of LA are well established and performed in our daily surgical practice. However, we do not yet have widespread clear clinical evidence on potential benefits regarding the clinical outcome after LA. Finally, at this time, the downsides seem minimal, so we continue to use LA as an adjunct in patients with RC tears and RC tendons that are at risk.
Topics: Acromion; Humans; Rotator Cuff; Rotator Cuff Injuries; Shoulder; Shoulder Joint
PubMed: 35248226
DOI: 10.1016/j.arthro.2021.11.002 -
Clinics in Orthopedic Surgery Dec 2022The aim of this study was to assess whether the anteroposterior coverage of the acromion reflecting acromial morphology affects the rotator cuff tear (RCT) and tear...
BACKGROUND
The aim of this study was to assess whether the anteroposterior coverage of the acromion reflecting acromial morphology affects the rotator cuff tear (RCT) and tear size, in addition to the lateral coverage.
METHODS
Medical records of 356 patients with RCTs, concentric osteoarthritis, and calcific tendinitis identified using three-dimensional computed tomography between January 2016 and December 2017 were retrospectively analyzed. The patients were divided into group A (those with RCTs) and group B (those with concentric osteoarthritis or calcific tendinitis). Subsequently, group A was subdivided into three categories according to the size of RCTs: small-to-medium, large, and massive. The lateral coverage was measured through the lateral acromial angle (LAA) and critical shoulder angle (CSA), whereas the anteroposterior coverage was measured via the acromial tilt (AT), acromiohumeral interval (AHI) in the sagittal view, and anteroposterior coverage index (APCI) as a new radiologic parameter.
RESULTS
Between groups A and B, CSA (34.5° ± 3.4° and 30.8° ± 3.4°, respectively), APCI (0.83 ± 0.10 and 0.75 ± 0.08, respectively), and AHI (6.3 ± 2.0 mm and 7.8 ± 1.8 mm, respectively) were significantly different (all < 0.001), whereas LAA and AT did not show a significant difference between the groups ( = 0.089 and = 0.665, respectively). The independent predictive radiologic parameters of the RCT were the CSA, APCI, and AHI ( < 0.001, < 0.001, and = 0.043, respectively); among these, the APCI showed the highest regression coefficient (odds ratio = 2.82). The parameters associated with the size of RCTs were CSA ( = 0.022) and AHI, of which AHI, in particular, had the most significant effect on both small-to-medium and large tears (all < 0.001).
CONCLUSIONS
Large CSA, high APCI, and low AHI were predictors of RCTs, with the APCI showing the strongest correlation. In addition to the large CSA, low AHI also correlated with the size of RCTs and affected the entire size groups. We suggest that both the lateral coverage and anteroposterior coverage of the acromion should be considered essential factors for predicting the presence of RCTs and tear size.
Topics: Humans; Rotator Cuff Injuries; Acromion; Shoulder Joint; Rupture; Osteoarthritis; Tendinopathy
PubMed: 36518929
DOI: 10.4055/cios22073 -
EFORT Open Reviews May 2017The shape of the acromion differs between patients with degenerative rotator cuff tears and individuals without rotator cuff pathology.It can be assessed in the sagittal...
The shape of the acromion differs between patients with degenerative rotator cuff tears and individuals without rotator cuff pathology.It can be assessed in the sagittal plane (acromion type, acromion slope) and in the coronal plane (lateral acromion angle, acromion index, critical shoulder angle).The inter-observer reliability is better for the measurements in the coronal plane.A large lateral extension (high acromion index or high critical shoulder angle) and a lateral down-sloping of the acromion (low lateral acromion angle) are associated with full-thickness supraspinatus tears.The significance of glenoid inclination for rotator cuff disease is less clear.The postulated patho-mechanism is the compression of the supraspinatus tendon between the humeral head and the acromion. Bursal side tears might be caused by friction and abrasion of the tendon. Articular side tears could be due to impairment of the gliding mechanism between tendon fibrils leading to local stress concentration. Further research is needed to understand the exact pathomechanism of tendon degeneration and tear. Cite this article: 2017;2. DOI: 10.1302/2058-5241.2.160076. Originally published online at www.efortopenreviews.org.
PubMed: 28630752
DOI: 10.1302/2058-5241.2.160076