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Motion limitations will be most pronounced with external rotation
4%
43/1143
Persistent pain is likely
6%
65/1143
Will be equivalent to RSA without injury
36%
412/1143
Will be equivalent to patient's preoperative function
5%
52/1143
Will be inferior to RSA without injury
49%
562/1143
Select Answer to see Preferred Response
Acromial fracture is an uncommon complication that can have devastating effects after RSA. Inferior clinical results can be expected in those who sustain an acromial fracture following RSA. Acromial fracture have a reported incidence of 4-8%. They often result in inferior clinical outcomes and limited motion, most pronouced in shoulder elevation compared with that in patients with RSA without a fracture. Patients with an acromial fracture often complain of superior shoulder pain with an acute onset of loss of function. These injuries may be missed on plain radiographs in up to 20% of cases; CT scans may be needed to aid in the diagnosis. Treatment is most commonly nonoperative with sling immobilization for 6 weeks and then advancing activities as tolerated. Patients should be consuled that functional outcomes and motion are likely to be limited compared with a RSA without a fracture. Otto et al. reviewed the sensitivity of plain radiographs to detect scapular fractures after RSA and relevant risk factors. They reported that osteoporosis is a significant risk factor for scapular fractures after RSA. They concluded that advanced imaging may be needed to confirm the diagnosis. Teusink et al. retrospectively reviewed the effects of a postoperative scapular fracture after RSA. They reported inferior clinical results compared with controls, but still show improvement compared with their preoperative measurements. They concluded that patients with postoperative scapular fractures may have increased risk of revision. Hamid et al. reviewed fractures of the acromion after RSA. They reported that 74% of ASES respondents treated these patients nonoperatively and that 53% of respondents thought that acromial fractures after RSA led to reduced shoulder function, but without persistent pain. They concluded that most patients do not report chronic pain, and conservative management is a reasonable option for this complication. Figure A is the AP radiograph of the left shoulder demonstrating an acromion fracture Incorrect Answers: Answer 1: Limitation in motion following an acromial fracture is most pronouced with shoulder elevation Answer 2: Persistent, chonic pain is most commonly not present Answer 3: Functional outcomes and motion is likely to be inferior to a RSA without acromial fracture Answer 4: Functional outcomes and motion will be improved compared to preoperative status, but inferior to a RSA without an acromial fracutre
3.7
(3)
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