Malunions and Nonunions of the Acromion and Coracoid Proceses: A Comparison of Functional Outcomes Before and After Reconstruction

Abstract

To assess surgical and functional outcomes in a cohort of patients having operatively reconstructed scapula process malunions and/or nonunions. Retrospective case series. Level I trauma center. Between 2003 and 2018, we identified 16 patients who presented to our institution with symptoms associated with a nonunion or malunion of closed, displaced fractures of the scapula processes after acute injury mechanisms. Surgical osteotomy of the malunion or debridement of the nonunion and subsequent reconstruction. The primary outcome measured included range of motion, strength, and DASH. Return to work was a secondary outcome. Among 13 of the 16 (81%) patients with ≥12 months follow-up, the mean follow-up was 34 months (range, 12-112 months). Three patients were lost to follow-up. The mean DASH score improved from 56.4 ± 22.4 preoperatively to 23.4 ± 22.2 postoperatively (P < 0.001). Among the patients with ≥1-year follow-up, range of motion improved from preoperative to final follow-up in abduction (P = 0.020). Among the 15 of 16 patients for whom occupation data are available, 73% either returned to their original occupation (n = 7) or did not due to reasons other than their reconstructive surgery (n = 4). Two postoperative complications occurred including failure of acromion nonunion fixation at 4 months and went on to heal after revision surgery. All reconstructions united without malunion. Reconstruction of the scapula process malunion and nonunion is possible, providing restoration of function and symptom relief, with a low complication rate. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.