Internal fixation of symptomatic os acromiale: a series of twenty-six cases

doi:10.1016/j.jse.2004.01.023

Journal of Shoulder and Elbow Surgery

Volume 13, Issue 4, July–August 2004, Pages 381-385

https://doi.org/10.1016/j.jse.2004.01.023 Get rights and content

Abstract

Twenty-six patients who presented to our shoulder service with a symptomatic meso–os acromiale were reviewed. All had been initially treated for impingement symptoms. Nonoperative treatment had failed in all patients. One patient had also undergone an arthroscopic acromioplasty without benefit. The diagnosis of symptomatic os acromiale was made on the basis of radiographs and point tenderness over the acromion coupled with signs of rotator cuff pathology. We assessed these patients after treatment by internal fixation and bone grafting. Fixation was achieved with either K-wires or screws and tension banding with either wire or suture. Fifteen patients had associated rotator cuff tears. The clinical and radiologic results are reported. The rate of union was 96% (25/26), and 24 of 26 patients (92%) were satisfied with their results. The mean time to union was 4 months. There were two postoperative fractures. Eight patients (thirty-one percent) had postoperative pain that was subsequently relieved by wire or screw removal. Seventeen patients had concomitant rotator cuff tears. Eleven cuff tears were repaired, and six were irreparable. One of these six was extensively debrided. We conclude that open reduction–internal fixation of the symptomatic meso-acromion yields satisfactory results, and with the exception of hardware discomfort necessitating removal, minimal complications arise in the majority of cases.

Section snippets

Materials and methods

We reviewed a consecutive series of 26 patients (26 shoulders) treated surgically for symptomatic meso-acromion by the senior authors (D.H.S., J.S.H., and S.B.G.). There were 19 male and 7 female patients with a mean age of 54 years (range, 17-75 years). All male patients except one were manual workers or overhead athletes. Two patients had an asymptomatic contralateral os acromiale. Diagnostic criteria were the presence of discomfort caused by downward pressure on the mobile os (symptomatic

Os acromiale union

Of 26 patients, 25 (96%) had clinical and radiologic signs of union. The mean time to bony union in these 25 cases was 4 months (range, 6 weeks to 6 months). Of 26 patients, 24 (92%) were satisfied with the result of their surgery and fulfilled our criteria for successful treatment.

Nonunion

There was one nonunion still present at 12 months in a patient who was completely asymptomatic. This patient had a combination of screws and nonabsorbable suture tension band.

Acromial fracture

One fracture occurred lateral to a screw

Discussion

Asymptomatic os acromiale is a well-recognized clinical entity.4, 5, 8 An ununited os may cause rotator cuff impingement or rotator cuff tear or remain symptomatic.7, 9, 13 Treatment options described include arthroscopic acromioplasty, open acromioplasty, fragment excision with deltoid reattachment, and fragment fixation with or without bone graft. Rotator cuff repair is performed when appropriate.1, 3, 5, 7, 10, 13 Open or arthroscopic acromioplasty can successfully relieve pain in some

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Open acromion fracture with a massive rotator cuff tear: A rare injury, case report
2023, International Journal of Surgery Case Reports
The combination of an open acromion fracture with a massive rotator cuff tear is an exceptional lesion, rarely described in the literature. It generally occurs after open shoulder trauma, and requires well-codified therapeutic measures to avoid complications that could keep the patient from being as autonomous as possible and able to perform daily activities.
We report the case of a 26-year-old patient with a wound on the posterior surface of the left shoulder following an attack. Standard X-ray showed a fracture of the acromion. Surgical exploration revealed a rupture of the supraspinatus and infraspinatus tendons. Internal fixation with a cancellous screw was performed for the acromion fracture after rotator cuff tendons repair. At the last follow-up, we obtained very encouraging functional and radiological results.
This combination of lesions is extremely rare, and few authors have discussed it. There is no universally accepted surgical technique for the repair of this type of injury, and too many techniques have been described.
It's a rare and serious shoulder injury, compromising the functional prognosis of the injured upper limb, hence the importance of correct initial medical and surgical management to avoid the development of chronic injuries with severe functional and professional repercussions for the patient.
Open reduction internal fixation of acromion fracture with open rotator cuff repair: a case report
2020, JSES International
The unstable os acromiale: a cause of pain in the young athlete
2020, JSES International
Os acromiale is a common entity in the middle-age group, in whom it is frequently associated with rotator cuff tears. However, it can be a cause of shoulder pain in the young athletes. We want to increase awareness of this pathology that may occultly affect the young athlete as well as to present the results of a perfusion-preserving arthrodesis.
Four consecutive young patients (17-21 years old) with a history of at least 6 months of unrecognized shoulder pain were surgically treated for os acromiale. Through a superior approach, stabilization of the neo-joint by means of cannulated screws and autogenic graft augmentation was performed.
Union of the os acromiale was achieved in all the patients. They had an excellent functional outcome, reaching all the maximum Simple Shoulder Test (12) and Oxford shoulder Score (48) scores. All the patients were able to return to their previous sports level.
Awareness of the os acromiale in the young athlete, appropriate clinical examination, and image studies are crucial to confirm diagnosis. Surgical treatment aiming at fusion in situ has shown excellent result.
Os acromiale: systematic review of surgical outcomes
2020, Journal of Shoulder and Elbow Surgery
The literature is unclear as to the optimal surgical management of a symptomatic os acromiale that has failed nonoperative treatment. Surgical options include excision, acromioplasty, and open reduction and internal fixation. The purpose of this study is to summarize the described methods and compare their reported outcomes with the goal to provide direction on how to surgically manage os acromiale.
We performed a systematic review of the current medical literature. Fifteen studies met all the inclusion criteria. Two hundred eleven total subjects (220 shoulders) underwent surgical treatment for a symptomatic os acromiale. There were 140 men and 71 women with a mean age of 49.6 ± 9.1 years. The mean follow-up duration was 40 ± 11.6 months. Surgical techniques used in the included studies were excision, acromioplasty, and open reduction with internal fixation. Concurrent surgical procedures performed were also included.
Meso-os acromiale was the most common type (167 cases, 94.4%). The most common surgical technique was internal fixation (135 cases, 60.8%), with screw fixation being the majority (76 cases, 56.3%). Excision (65 cases, 29.3%) was the second most used technique. The most common concurrent surgical procedure performed was rotator cuff repair (125 cases, 56.3%), followed by distal clavicle excision (31 cases, 14%).
All surgical techniques employed resulted in improvement in postsurgical clinical outcomes without any technique demonstrating superior results. Operative management of a symptomatic os acromiale that has failed initial nonoperative treatment leads to decreased symptoms and improvement in clinical outcomes.
Os acromiale open reduction and internal fixation: a review of iliac crest autogenous bone grafting and local bone grafting
2018, Journal of Shoulder and Elbow Surgery
Citation Excerpt :
In their series, cannulated screws and iliac crest bone graft did much better than cerclage and Kirschner wires, suggesting the type of fixation was a factor in the progression to union, as was the use of an iliac crest bone graft. Peckett et al11 reported a high union rate of 96% symptomatic os acromiale fixation using a local bone graft. In their study, a tension band construct was applied using a few fixation methods: 17 were treated with 2 cannulated screws, 5 with 2 Kirschner wires, and 4 with 1 Kirschner wire and a compression screw.
Symptomatic os acromiale are fairly uncommon, and treatment has included fragment excision, decompression, and open reduction and internal fixation. Nonunion rates as high as 40% have been reported after fixation of os acromiale. This study assessed whether union of an os acromiale could be reliably achieved without the use of an iliac crest bone graft.
This was a retrospective study of 32 consecutive shoulders that were treated with screw fixation and a local bone graft or iliac crest bone graft. The mean age was 50.3 years (range, 21-74 years), and the mean follow-up was 46.9 months (range, 12-120 months). Fusion was assessed clinically and radiologically.
All 32 os acromiale were fused by 3 months on x-ray imaging. There were 18 shoulders in the iliac crest bone graft group and 14 in the local bone graft group. Rotator cuff repairs were performed concomitantly in 25 patients. Hardware was removed in 4 patients, a seroma was drained in 1 patient, and a superficial infection occurred in 1 patient.
This is the largest study of os acromiale fixation using screws and a tension band to our knowledge. We report a 100% union rate using this technique, with 13% requiring hardware removal and the occurrence of 1 superficial infection. This study shows a local bone graft is as effective as iliac crest bone graft in achieving fusion.
Operative Fixation of Symptomatic Os Acromiale
2018, Operative Techniques: Shoulder and Elbow Surgery

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Original articleInternal fixation of symptomatic os acromiale: a series of twenty-six cases☆

Abstract

Section snippets

Materials and methods

Os acromiale union

Nonunion

Acromial fracture

Discussion

Arthroscopy

J Shoulder Elbow Surg

The surgical treatment of an unfused acromial epiphysis in association with a tear of the rotator cuffa review of 41 cases

J Shoulder Elbow Surg

The relationship between the unfused acromial epiphysis and subacromial impingement lesions

Orthop Trans

Os acromiale in a professional tennis player

Am J Sports Med

Os acromialeanatomy and surgical implications

J Bone Joint Surg Br

Original article
Internal fixation of symptomatic os acromiale: a series of twenty-six cases☆