Managing acromial fractures: prevention and treatment, both nonoperative and operative

Abstract

Acromial and scapular spine fractures are a known complication in 3.1% to 11.2% of reverse shoulder arthroplasties and can cause significant functional impairment. Acromial and scapular spine fractures often present as increased shoulder pain and may have unremarkable plain radiographs and thus require further imaging for diagnosis. A number of risk factors for these fractures have been proposed in the literature with varying level of evidence. Risk factors may be grouped into patient comorbidities, pre-operative acromial pathology, surgical technique, and surgical indications. Ideally, acromial and scapular spine fractures in reverse shoulder arthroplasty patients can be prevented by identifying and addressing risk factors pre-operatively and intra-operatively. Treatment of acromion and scapular spine fractures after reverse shoulder arthroplasty depends on the fracture location, displacement, and patient factors and includes both non-surgical management and surgical fixation. This article aims to serve as a comprehensive review of the available literature on acromial and scapular spine fractures in reverse shoulder arthroplasty patients and suggested methods of prevention and treatment.