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