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Shoulder & Elbow Jul 2017Even though reverse shoulder arthroplasty is a very successful procedure, painful complications occur. During the initial postoperative years, the most common reasons... (Review)
Review
Even though reverse shoulder arthroplasty is a very successful procedure, painful complications occur. During the initial postoperative years, the most common reasons for pain are instability, postoperative fracture of the acromion or spine, and periprosthetic infection. Later, aseptic loosening, with humeral loosening being more frequent that glenoid loosening, can be a source of pain and reduction in function. A careful patient history, clinical examination, plain radiographs, computed tomography and blood tests give an explanation for the pain in most cases. The majority of these complications can be successfully treated, maintaining a functional reverse shoulder arthroplasty. However, if all examinations are normal, it is important to remember that nonshoulder conditions such as tumour of the lung or degenerative changes of the cervical spine can give shoulder pain.
PubMed: 28588662
DOI: 10.1177/1758573217702333 -
Archives of Orthopaedic and Trauma... Sep 2023There is no widely accepted standard for the classification and treatment of traumatic acromion/scapular spine fracture nonunion due to the scarcity of this condition... (Review)
Review
INTRODUCTION
There is no widely accepted standard for the classification and treatment of traumatic acromion/scapular spine fracture nonunion due to the scarcity of this condition and the confusion of terminology.
MATERIALS AND METHODS
PubMed and Scopus were searched using "scapular fracture" and "acromion fracture" or "scapular spine fracture" as search terms. The inclusion criteria were English full-text articles concerning acromion/scapular spine fracture nonunion that described patient characteristics and presented appropriate images. The exclusion criteria were cases without appropriate images. Citation tracking was conducted to find additional articles and notable full-text articles written in other languages. Fractures were classified using our newly proposed classification system.
RESULTS
Twenty-nine patients (19 men, 10 women) with 29 nonunions were identified. There were four type I, 15 type II, and 10 type III fracture nonunions. Only 11 fractures were isolated. The mean period from initial injury to final diagnosis was 35.2 ± 73.2 months (range 3-360 months) (n = 25). The most frequent cause of delayed diagnosis was conservative treatment for fracture in 11 patients, followed by oversight by the physician in 8. The most common reason for seeking medical advice was shoulder pain. Six patients received conservative therapy, and 23 received operative treatment. Fixation materials included various plates in 15 patients, and tension band wiring in 5. Bone grafting was performed in 16 patients (73%, 16/22). Of the 19 surgically treated patients with adequate follow-up, the outcome was rated excellent in 79%.
CONCLUSIONS
Isolated acromion/scapular spine fracture nonunion is rare. Fracture type II and III, arising in the anatomical scapular spine, accounted for 86% of the fractures. Computed tomography is required to prevent fracture oversight. Surgical therapy produces good stable results. However, it is important to select the appropriate surgical fixation method and material after considering the anatomical characteristics of the fracture and stress on the fractured portion.
LEVEL OF EVIDENCE
V.
Topics: Male; Humans; Female; Acromion; Spinal Fractures; Fractures, Bone; Scapula; Fracture Fixation, Internal; Fractures, Ununited; Shoulder Fractures; Treatment Outcome
PubMed: 37314525
DOI: 10.1007/s00402-023-04912-z -
International Orthopaedics Dec 2020Fractures of the acromion and the scapular spine are serious complications after reverse total shoulder arthroplasty. They concern about 4 to 5% of the patients and... (Review)
Review
PURPOSE
Fractures of the acromion and the scapular spine are serious complications after reverse total shoulder arthroplasty. They concern about 4 to 5% of the patients and always result in a significant deterioration of shoulder function. Different causes have been taken into consideration, particularly stress or fatigue fractures. The purpose of the present study was to analyse our own cases and to discuss the causes reported in the literature.
METHODS
We reviewed our shoulder arthroplasty registry and the consultation reports of the last ten years. The charts and radiographs of all patients who had a post-operative fracture of the acromion or the scapular spine were carefully examined and the results were compared with those of an age- and gender-matched control group.
RESULTS
Twelve patients with an average age of 79 years sustained a fracture of the acromion (n = 6) or the scapular spine (n = 6). The time interval between the operation and the fracture averaged 26 months and ranged from three weeks to 70 months. Eight patients (67%) had a trauma. Seven of them reported a fall on the corresponding shoulder and one a heavy blow on the acromion. The four non-traumatic fractures were attributed to poor bone quality. All 12 patients had immediate pain and difficulty to actively elevate the affected arm. The time interval between the fracture and its diagnosis averaged ten weeks (0 to 10 months). At final follow-up, all patients could reach their face and refused further surgery. Two patients rated their result as good, six as acceptable and four as poor.
CONCLUSIONS
Our study cannot support the hypothesis that most acromion and scapular spine fractures after RSA are the result of increased tension in the deltoid or stress fractures. In our series, the majority of the fractures were related to a fall. Implantation of a reverse prosthesis exposes the acromion and makes it more vulnerable to direct trauma. Non-traumatic fractures were associated with poor bone quality.
Topics: Acromion; Aged; Arthroplasty, Replacement, Shoulder; Fractures, Bone; Humans; Retrospective Studies; Shoulder Fractures; Shoulder Joint; Spinal Fractures
PubMed: 32995915
DOI: 10.1007/s00264-020-04813-5 -
The Indian Journal of Radiology &... Oct 2021Acromion is essential for stabilizing the shoulder complex. Tumors of the acromion are rare. We report the largest series of acromion tumor and tumor-like lesion....
Acromion is essential for stabilizing the shoulder complex. Tumors of the acromion are rare. We report the largest series of acromion tumor and tumor-like lesion. A retrospective review of the oncology and radiology database within our tertiary center for orthopaedic oncology was performed to identify all tumors of the acromion over the past 30 years and imaging was reviewed. We identified a total of 31 lesions arising in the acromion and chondrosarcoma was the commonest. One needs to be aware of tumor and tumor-like lesions of acromion.
PubMed: 35136496
DOI: 10.1055/s-0041-1735916 -
Arthroscopy Techniques Dec 2017Acromioclavicular (AC) joint arthropathy remains one of the most common causes of shoulder pain. In the case of AC joint arthropathy resistant to conservative treatment,...
Acromioclavicular (AC) joint arthropathy remains one of the most common causes of shoulder pain. In the case of AC joint arthropathy resistant to conservative treatment, most authors have recognized distal clavicle resection as the gold-standard treatment. However, some challenges remain to be solved. One is the difficulty in visualization of the superior and posterior part of the distal clavicle from the midlateral portal, causing an incomplete resection of the distal clavicle. This could potentially lead to unresolved pain and therefore surgical failure. We propose a technique for arthroscopic resection of the distal clavicle and the medial portion of the acromion, without any added portal: bipolar AC joint resection. The term "bipolar" is used because both the acromion and the clavicle are resected, without injuring the superior capsule.
PubMed: 29349023
DOI: 10.1016/j.eats.2017.08.027 -
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 -
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 -
Orthopaedics & Traumatology, Surgery &... Apr 2022Scapular morphology is an extrinsic factor playing role in rotator cuff tear (RCT) etiology. The objective of this study was to evaluate the relationship between...
PURPOSE
Scapular morphology is an extrinsic factor playing role in rotator cuff tear (RCT) etiology. The objective of this study was to evaluate the relationship between critical shoulder angle (CSA) and acromion index (AI) with partial-bursal side and full thickness RCT and the size of the RCT.
HYPOTHESIS
The hypothesis was that CSA and AI would be greater in partial bursal-side RCT and full-thickness RCT patients and would increase with the size of the RCT.
METHODS
This retrospective study assessed 218 patients who had standard shoulder radiographs and magnetic resonance imaging. Patients were divided into three groups: intact rotator cuff (68), partial bursal-side RCT (34) and full-thickness RCT (116). In the second part, full-thickness RCT patients were divided into four groups according to RCT size; small (<1cm), medium (1-3cm), large (3-5cm) and massive (>5cm). AI and CSA measurements were evaluated from radiographs.
RESULTS
The mean CSA was 32.8̊ in control group, 34.3̊ in partial group and 36.9̊ in full-thickness group. The mean AI was 0.66, 0.68 and 0.72 respectively. Significant difference was found in AI and CSA between full thickness RCT and intact RC group (p<0.01), and partial RCT and full thickness RCT group (p<0.05) in paired comparisons. In full thickness RCT size groups the mean CSA was 34.2̊, 36.4̊, 39.0̊ and 40.8̊ and mean AI was 0.70, 0.71, 0.73 and 0.79 respectively. Significant difference was found between small-large, small-massive, medium-massive groups for CSA in paired comparisons and between small-massive, medium-massive groups for AI.
CONCLUSION
CSA and AI were significantly greater in full-thickness RCT patients and the size of the RCT increased with CSA and AI. The greater CSA and AI could be predictors for larger RCT.
LEVEL OF EVIDENCE
III; Cross-Sectional Design; Prognosis Study.
Topics: Acromion; Humans; Rotator Cuff; Rotator Cuff Injuries; Shoulder; Shoulder Joint
PubMed: 34687950
DOI: 10.1016/j.otsr.2021.103122 -
Medicine Oct 2022This study aimed to radiologically evaluate the effect of hook plates used in the treatment of acromioclavicular joint (ACJ) dislocations on the development of...
This study aimed to radiologically evaluate the effect of hook plates used in the treatment of acromioclavicular joint (ACJ) dislocations on the development of subacromial osteolysis (SAO) according to acromion types. A total of 43 patients with mean age of 38.5 (19-77) years who were diagnosed with AC dislocation and applied neutral clavicular hook plate between 2013 and 2020 were retrospectively evaluated. Acromion types were determined by measuring acromion slope angle on lateral shoulder radiography and 3-dimensional (D)-CT of the patients. Presence of SAO was classified according to the severity of erosion in the subacromial region (grade I: minimal osteolysis, grade II: subacromial erosion <2 mm, grade III: subacromial erosion >2 mm, grade IV: cut-through of the acromion) on postoperative 3D - CT and correlation with acromion types was analyzed. Incidence of SAO was significantly higher among type 1 acromion compared to type 2 and type 3 acromion (P = .003). While osteolysis was observed in 21 patients, no osteolysis was observed in 22 patients. Osteolysis occurred in all patients with type 1 acromion, 7 patients with type 2 acromion, and 5 patients with type 3 acromion. Since the hook tip in the sagittal plane passes posterior to the center of the acromion and the concavity of the subacromial surface is inadequate in the type 1 acromion, we believe that the increased pressure applied by the hook tip on the subacromial cartilage increases the risk of SAO. We predict that the use of hook plates with an angle of 15-20 degrees, similar to the patient's AC angle, rather than neutral hook plate, will reduce the risk of osteolysis in patients with type 1 acromion.
Topics: Humans; Adult; Middle Aged; Aged; Acromion; Acromioclavicular Joint; Clavicle; Retrospective Studies; Joint Dislocations; Bone Plates; Shoulder Dislocation; Osteolysis; Treatment Outcome
PubMed: 36316844
DOI: 10.1097/MD.0000000000031632