Acromial Fracture After Reverse Shoulder Arthroplasty

In this article, we report on our experience with patients who sustained a fracture of the acromion after reverse shoulder arthroplasty (RSA), and on the results of a comprehensive survey regarding this complication—a survey of American Shoulder and Elbow Surgeons (ASES) members.

Patients were assessed with radiographs and vali­dated functional outcome measures. Eight (4.9%) of the 162 patients that underwent RSA had radiographic evidence of postoperative fracture of the acromion. Mean active forward elevation was 71°, and mean ASES score was 70. Four patients reported no pain; 2 had mild pain; 1 had moderate pain; and 1 patient had severe pain. Six of the 8 fractures did not unite.

Survey results showed 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.

The natural history of nonoperative management is char­acterized by reduced global shoulder function and a high rate of nonunion. However, most of the patients who experi­enced this complication did not report chronic pain. Given these patients’ outcomes, and the surveyed opinions of ASES members, conservative management is a reason­able option for this complication.