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The acromion process is the lateral projection of the scapula spine that extends anteriorly. Fractures of the scapula are uncommon injuries and account for ~3% of all shoulder fractures 1,2 while isolated acromion fractures occur rarely and account for only 9% of all scapular fractures 3.
Mechanisms of injury
Acromial fractures usually occur as the result of direct trauma to the shoulder or superior dislocation of the humeral head 4.
Computed tomography is sometimes necessary when the shoulder radiographs are normal and when there is high clinical suspicion of acromial injury.
MRI and US exams are also helpful in the assessment of the soft tissues of the shoulder region 4,6.
Three types of acromial fracture are defined by Kuhn et al 7 which can help to determine whether surgical or non-surgical treatment is appropriate:
- type I: minimally displaced
- type II: displaced but does not reduce the subacromial space
- type III: displaced with narrowing of the subacromial space
Treatment and prognosis
Type I and II acromial fractures are usually managed with non-surgical treatment while type III fractures usually require surgery to prevent secondary impingement. A variety of surgical techniques can be used and include 7,8:
- tension band wiring
- reconstruction plate
- Kirshner wire
Os acromiale is an unfused acromion accessory ossification center which is relatively common and found in ~8% of the population 9,10. It is bilateral in ~ 60% of individuals 11.
- 1. Kenneth A. Egol, Kenneth J. Koval, Joseph David Zuckerman. Handbook of Fractures. (2019) ISBN: 9781605477602
- 2. Charles A. Rockwood, Robert W. Bucholz, Charles M. Court-Brown, James D. Heckman, Paul Tornetta. Rockwood and Green's Fractures in Adults. (2019) ISBN: 9781605476773
- 3. Goodrich JA, Crosland E, Pye J. Acromion fracture associated with posterior shoulder dislocation. (1998) Journal of orthopaedic trauma. 12 (7): 521-3. doi:10.1097/00005131-199809000-00018 - Pubmed
- 4. Getz C, Deutsch A, Williams Junior GR. Scapular and glenoid fractures. In: Jon J. P. Warner, Joseph P. Iannotti, Evan L. Flatow. Complex and Revision Problems in Shoulder Surgery. (2005) ISBN: 9780781746588 - Google Books. pp. 378-80.
- 5. Jamie Weir, Peter H. Abrahams. Imaging Atlas of Human Anatomy. (2019) ISBN: 9780723434573
- 6. Kuhn JE, Blasier RB, Carpenter JE. Fractures of the acromion process: a proposed classification system. (1994) Journal of orthopaedic trauma. 8 (1): 6-13. doi:10.1097/00005131-199402000-00002 - Pubmed
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- 8. Athanasios Papatheodorou, Panagiotis Ellinas, Fotios Takis, Antonios Tsanis, Ioannis Maris, Nikolaos Batakis. US of the Shoulder: Rotator Cuff and Non–Rotator Cuff Disorders1. (2006) RadioGraphics. 26 (1): e23. doi:10.1148/rg.e23 - Pubmed
- 9. Michael B. Zlatkin. MRI of the Shoulder. (2019) ISBN: 9780781715904