Fractures of the acromion
Acromion fractures require surgical stabilization as the fractured part, constitutes the roof of the shoulder against which the humeral head presses. Conservative treatment would expose too much to the risk of pseudarthrosis.
Access to the acromion is simple, as it is located directly under the skin and easily attacked. Patient in beach chair. I propose a skin incision that follows the posterior edge of the acromion or slightly more cranial and reaches the anterolateral edge.
The acromion and its fracture are exposed. This is followed by reduction of the fracture and temporary stabilization with 2 Kirschner wires (1.8-2).
We can synthesize the fracture in several ways:
- screws that run inside the acromion (from the lateral / anterolateral edge): at least 2, cancellous diameter 4.0 or similar - replace the 2 Kirschner wires
- a plate that follows the edge of the acromion associated with screws that cross the fracture: the plate is a third tubular bent along the edge of the acromion, the screws are 4.0 cancellous or 3.5 cortical. At least 1 screw must cross the fracture line. Compared to method a), we have greater stability since the plate further stiffens the synthesis. However, the third tubular does not have a high mechanical strength and protrudes slightly beyond the edge of the acromion; after healing, it must be removed. I propose a new method using a reconstruction plate with higher mechanical strength:
- 3.5 reconstruction plate which rests cranially on the acromion. The same is fixed on the spine scapulae posteriorly. The part towards the lateral edge of the acromion is bent so that a screw can be inserted that crosses the fracture and that is inside the acromion.
Postoperative treatment: using the method with a cranial reconstruction plate. Immobilization with Gilchrist / Desault or 20 ° abduction orthosis for 4 weeks. Beginning with passive mobilization 10-14 days after surgery. Active mobilization not earlier than 6 weeks after surgery.