Abstracts

Isolated Acromion Fracture: A Case Report

Kyle P. Stephenson, DO, MSa, Douglas Dietzel, DOa,b

aMcLaren-Greater Lansing Orthopedic Hospital, Lansing, MI, USA
bMichigan State University Sports Medicine, East Lansing, MI, USA

Introduction
Isolated acromion fractures are rare in the literature.   Moreover, majority of these fractures are treated nonoperatively.  The purpose of this case report is to present surgical indications, our surgical technique, and clinical follow-up in a rare orthopedic issue.  It also gives insight on the prognosis of this injury. 

Methods
We report on a 56-year-old male with an isolated acromial fracture after a snowmobile accident.  The fracture resulted in subacromial impingement and displacement > 1 cm, therefore the decision was made for operative fixation.  A posterior approach of the scapula was used and open reduction and internal fixation with a reconstruction plate was performed.

Results
Excellent functional outcome was achieved in regard to shoulder range of motion, strength, and retained subacromial space.  At two months postoperatively, his ROM improved to 1750 of flexion, 1750 abduction, 650 external rotation, and internal rotation/extension to L4.  Strength progressed to 5/5 in all planes. At his one-year follow-up, this patient denied pain and demonstrated full ROM and 5/5 strength.  Both ROM and strength are symmetric with the contralateral upper extremity.  He returned to work full-time without restrictions. 

Discussion
Although this injury is rarely seen and often treated nonoperatively, surgery may be performed to prevent rotator cuff tears secondary to subacromial impingement, painful nonunions or malunions, and decreased overall function of the shoulder.  

References

  1. Toivonen DA, Tuite MJ, Orwin JF. Acromial structure and tears of the rotator cuff. J Shoulder Elb Surg Am Shoulder Elb Surg Al. 1995;4(5):376-383.
  2. Levy JC, Anderson C, Samson A. Classification of postoperative acromial fractures following reverse shoulder arthroplasty. J Bone Joint Surg Am. 2013;95(15):e104. doi:10.2106/JBJS.K.01516.
  3. Kuhn JE, Blasier RB, Carpenter JE. Fractures of the acromion process: a proposed classification system. J Orthop Trauma. 1994;8(1):6-13.
  4. Wilber MC, Evans EB. Fractures of the scapula. An analysis of forty cases and a review of the literature. J Bone Joint Surg Am. 1977;59(3):358-362.
  5. Epstein RE, Schweitzer ME, Frieman BG, Fenlin JM, Mitchell DG. Hooked acromion: prevalence on MR images of painful shoulders. Radiology. 1993;187(2):479-481. doi:10.1148/radiology.187.2.8475294.
  6. Hawkins RJ, Kennedy JC. Impingement syndrome in athletes. Am J Sports Med. 1980;8(3):151-158.
  7. Hill BW, Anavian J, Jacobson AR, Cole PA. Surgical management of isolated acromion fractures: technical tricks and clinical experience. J Orthop Trauma. 2014;28(5):e107-e113. doi:10.1097/BOT.0000000000000040.
  8. Bigliani LU, Ticker JB, Flatow EL, Soslowsky LJ, Mow VC. The relationship of acromial architecture to rotator cuff disease. Clin Sports Med. 1991;10(4):823-838.
  9. Mayerhoefer ME, Breitenseher MJ, Wurnig C, Roposch A. Shoulder impingement: relationship of clinical symptoms and imaging criteria. Clin J Sport Med Off J Can Acad Sport Med. 2009;19(2):83-89. doi:10.1097/JSM.0b013e318198e2e3.
  10. Thompson JC, Netter FH. Netter’s Concise Orthopaedic Anatomy. Philadelphia, PA: Saunders Elsevier; 2010. http://site.ebrary.com/id/10422733. Accessed February 17, 2015.

Back to top