Causes of acromion and scapular spine fractures following reverse shoulder arthroplasty: a retrospective analysis and li
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ORIGINAL PAPER
Causes of acromion and scapular spine fractures following reverse shoulder arthroplasty: a retrospective analysis and literature review Richard W. Nyffeler 1
&
Bartu Altioklar 1 & Philipp Bissig 1
Received: 25 October 2019 / Accepted: 15 September 2020 # The Author(s) 2020
Abstract Purpose Fractures of the acromion and the scapular spine are serious complications after reverse total shoulder arthroplasty. They concern about 4 to 5% of the patients and always result in a significant deterioration of shoulder function. Different causes have been taken into consideration, particularly stress or fatigue fractures. The purpose of the present study was to analyse our own cases and to discuss the causes reported in the literature. Methods We reviewed our shoulder arthroplasty registry and the consultation reports of the last ten years. The charts and radiographs of all patients who had a post-operative fracture of the acromion or the scapular spine were carefully examined and the results were compared with those of an age- and gender-matched control group. Results Twelve patients with an average age of 79 years sustained a fracture of the acromion (n = 6) or the scapular spine (n = 6). The time interval between the operation and the fracture averaged 26 months and ranged from three weeks to 70 months. Eight patients (67%) had a trauma. Seven of them reported a fall on the corresponding shoulder and one a heavy blow on the acromion. The four nontraumatic fractures were attributed to poor bone quality. All 12 patients had immediate pain and difficulty to actively elevate the affected arm. The time interval between the fracture and its diagnosis averaged ten weeks (0 to 10 months). At final follow-up, all patients could reach their face and refused further surgery. Two patients rated their result as good, six as acceptable and four as poor. Conclusions Our study cannot support the hypothesis that most acromion and scapular spine fractures after RSA are the result of increased tension in the deltoid or stress fractures. In our series, the majority of the fractures were related to a fall. Implantation of a reverse prosthesis exposes the acromion and makes it more vulnerable to direct trauma. Non-traumatic fractures were associated with poor bone quality. Keywords Acromion fracture . Scapula fracture . Stress fracture . Reverse shoulder prosthesis . Rotator cuff tear
Introduction Reverse shoulder arthroplasty (RSA) has become a standard procedure for the treatment of elderly patients with pain and severe functional impairment of the shoulder. The short- and mid-term results are good [1, 2]; the rate of peri- and postoperative problems and complications, however, is relatively high [3–6]. They include limited range of motion [7–9], scapular notching [10, 11], instability [12, 13], component loosening [3, 14, 15] and fractures of the acromion and scapular spine [16–29]. The cause of these fractures is still controversial. Some authors consider them as stress fractures [16, 17, 22–24, 26] or
* Richard W. Nyff
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