Acromial Stress Fracture Following Reverse TSA in 69F

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PRESENTATION
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POLLS
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OUTCOMES
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VIDEOS
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EVIDENCE
27
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Comments
17
CASE DESCRIPTION
AGE 69 / Female
CC L shoulder pain
HPI A 69-year-old female presents for evaluation of left shoulder pain. The patient has undergone a prior left TSA in 2016 and had done well for 3 years prior to requiring conversion to a reverse TSA. Postoperatively from the rTSA she did well for 2 months before presenting to the clinic with a complaint of severe pain after feeling a pop on the top of the shoulder. She denies any direct trauma or falls, no numbness or tingling in the arm or hand.
PMH Medical history: Chronic kidney disease, hypertension, thoracic outlet syndrome Surgical history: L TSA, L conversion to reverse TSA (2019), R reverse TSA, bilateral TKA, thoracic outlet surgery
PE Focused physical exam of the left upper extremity shows well healed surgical incision over the anterior shoulder. Focal tenderness over the lateral acromion. There is pain with abduction of the shoulder. Sensation and motor are intact distally with 2+ pulses in the hand.
Pre-procedure IMAGES:
https://upload.orthobullets.com/cases/101748/02691f3b-20ba-4249-a610-1c921c647ae9_rtsa_1.jpg https://upload.orthobullets.com/cases/101748/1c9e2622-77c9-4a1e-b2fe-00eefd5b1594_rtsa_2.jpg https://upload.orthobullets.com/cases/101748/3ffd393f-5566-4362-bd07-caf5103643f7_rtsa_3.jpg https://upload.orthobullets.com/cases/101748/bcd8de98-d591-4c6b-a376-2ca88fe5a1df_acromion_1.jpg https://upload.orthobullets.com/cases/101748/4b75097c-73a1-42a2-b06d-1af72c53ef38_acromion_2.jpg https://upload.orthobullets.com/cases/101748/72e7bc8d-cf47-4471-bc69-b630131f5648_acromion_3.jpg
Pre-procedure VIDEOS:
video
POLLS
OB Community
1) In addition to the plain radiographs above, would you obtain any additional imaging to guide treatment?
Other
2) Would you use a classification system to guide your management?
Other
3) How would you manage this patient's acromial fracture?
Other
4) If you choose Nonoperative management, what would you do with respect to immobilization?
Other
5) If you choose Nonoperative management, how long would you monitor patient prior to offering operative management if still symptomatic?
Other
6) If you choose Operative management, what technique would you choose?
Other
7) If you choose Open reduction and internal fixation (ORIF), what fixation would you use?
Other
8) If you choose Open reduction and internal fixation (ORIF), how would you position the patient?
Other
9) If you choose Open reduction and internal fixation (ORIF), would you augment with bone graft at the fracture site?
Other
10) If you choose Operative management and attained the construct shown below, how would you manage post-operative weight-bearing?
Other
CASE OUTCOMES
PROCEDURE 1: ORIF acromial stress fracture
Intra-procedure P1
https://upload.orthobullets.com/cases/101748/a32f3890-0fef-4fb1-8051-ff88342dcfbe_a_orif_1.jpg https://upload.orthobullets.com/cases/101748/b344c21b-3b6d-4a83-a355-e43d3999c1b6_a_orif_2.jpg
Post-procedure P1
https://upload.orthobullets.com/cases/101748/1ac270cc-375e-4790-b7b9-9a668b640131_a_orif_3.jpg https://upload.orthobullets.com/cases/101748/11cd62cf-69da-4bd3-91fe-20f3a5b8324d_a_orif_4.jpg
VIDEOS & PODCASTS (4)
EVIDENCE (27)
EXPERT COMMENTS