Executive Editor: Joseph Schatzker

Authors: Jonas Andermahr, Michael McKee, Diane Nam

Scapula Body and processes, acromion

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Glossary

General considerations

Due to the displacement forces of the arm, the fractures of the acromion are most often displaced and most often treated operatively.

Nonoperative treatment
Main indication Skill Equipment
Non displaced fractures and no additional lesions to the shoulder girdle Basic surgical experience, no specialized skills Basic equipment only


Advantages

  • No operative risks
  • No anaesthetic  risk

Disadvantages

  • Possible need for hardware removal
  • Increased frequency of X-ray follow up

Contraindication

  • Additional lesion of the LSSS or other fractures of the shoulder girdle
ORIF - Lag screw fixation
Main indication Skill Equipment
Displaced fractures Some specialized surgical experience Basic equipment only


Supporting indications

  • Presence of associated injuries to the shoulder girdle
  • Need for more stability and/or earlier mobilization

Advantages

  • Reduced risk of displacement
  • Earlier mobilization possible
  • In case of minor comminution, screws will offer better stability than tension band alone

Disadvantages

  • Possible need for hardware removal

Contraindications

  • Patient unfit for surgery
  • Severe osteoarthritis
ORIF - Tension band
Main indication Skill Equipment
Displaced fractures Some specialized surgical experience Basic equipment only


Some fracture patterns may be so complex as to make fixation of a part or all of it not possible.

Supporting indications

  • Need for more stability and/or earlier mobilization

Advantages

  • Reduced risk of displacement
  • Earlier mobilization possible

Disadvantages

  • Possible need for hardware removal
  • Risk of nerve injury to the axillary and suprascapular nerve.

Contraindications

  • Patient unfit for surgery
  • Severe osteoarthritis
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

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