1 Introduction topenlarge
The majority of isolated acromial factures can be managed non-operatively.
However, typically most acromial fractures are associated with more complex fractures of the scapula, and/or clavicle, and may also involve the suspensory ligament complex.
Any disruption of the ligament complex is treated as described in the section of LSSS.
Most of the acromion is cancellous bone and provided poor fixation for screws.
2 Approach topenlarge
For simple fractures of the acromion, a superior approach is recommended. For complex injuries a modified deltopectoral approach is preferred.
For associated complex injuries requiring an anterior approach, an extended delta pectoral approach may be used (eg. coracoid, glenoid, proximal humerus fractures).
3 Reduction and fixation topenlarge
Reduction is best achieved using a reduction clamp.
In a pure transverse fracture, a tension band alone will suffice but where some comminution is present, it is better to use two lag screws supplemented with a tension band.
For a pure tension band, a K-wire is inserted from the lateral side and directed slightly posteriorly so that it exists the spine of the scapula on the other side of the fracture. A second K-wire is inserted parallel to the first with the help of a parallel drill guide. Both K-wires should protrude 5 mm dorsally.
Check the position of the K-wires with an image intensifier to make sure they are not inserted subacromially and have penetrated the rotator cuff or other structures.
Drill with the 2 mm drill bit a transverse hole through the spine of the scapula, at least 2-3 cm distal to the fracture. Then insert the wire through the transverse hole and then around the two K-wires in such a way that you will tighten simultaneously both the loop and the wires. This will achieve symmetrical tension in both wires.
The lateral ends of the K-wires are bent to a 90 degree angle and cut, leaving a 1 cm stump.
This will pull the K-wires 2-3 mm laterally.
The 90 degree angle is then further bent to a 180 degree angle before the "hook" is sunk into the bone. This will restore the 5mm protrusion of the K-wires dorsally.
Check the reduction and fixation with an image intensifier.