From the Guidelines
Acromion fractures should be managed conservatively with a focus on pain control and gradual return to function, reserving surgery for significantly displaced or complex fractures. When managing acromion fractures, it is essential to prioritize a treatment approach that minimizes morbidity, mortality, and optimizes quality of life. The initial treatment includes rest, ice application, and pain management with NSAIDs, such as ibuprofen (400-600mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks, as well as the use of a sling for comfort for 2-3 weeks, followed by progressive range of motion exercises 1. Key considerations in the management of acromion fractures include:
- The size and displacement of the fracture fragments
- The presence of associated injuries, such as rotator cuff tears
- The patient's overall health status and activity level Physical therapy is recommended starting at 3-4 weeks post-injury, focusing on shoulder mobility and strengthening. Most acromion fractures heal within 6-8 weeks with conservative management. Surgery is typically reserved for fractures that are significantly displaced (>1cm), cause impingement, or have associated rotator cuff injuries, with surgical options including open reduction and internal fixation with plates and screws. Regular follow-up with radiographic assessment at 2,6, and 12 weeks is recommended to ensure proper healing and alignment. It is crucial to note that the diagnosis of acromion fractures is based on a history of trauma, focal pain on palpation, and confirmation with radiographic studies, as outlined in the american college of foot and ankle surgeons guidelines 1.
From the Research
Acromion Fracture Management
- Acromion fractures are rare and often occur with concomitant fractures of the ipsilateral glenoid, neck, and body of the scapula as sequelae of high-energy injuries 2, 3.
- There is no common accepted treatment scheme and fixation method for acromion fractures, and current recommendations are often based on a limited number of cases 3.
- Displaced acromion fractures can be treated with open reduction and internal fixation (ORIF), which can help to achieve fracture union and prevent complications such as subacromial impingement and rotator cuff injury 2, 4.
- Nonoperative treatment of acromion fractures can be considered, but it may result in inferior clinical outcomes and a higher rate of nonunion, especially in medial fracture subtypes 5.
- Surgical management of isolated acromion fractures can be effective in achieving fracture union and improving clinical outcomes, and can be performed using a direct posterior approach with tension band or low-profile plating and cortical lag screws 6.
Indications for Operative Management
- Symptomatic nonunion
- Displaced fractures
- Acromion fractures associated with other lesions of the superior shoulder suspensory complex
- Less displaced acromion fractures resulting in decreased subacromial space 3, 6