From the Research
The treatment approach for pediatric os acromiale is primarily conservative management, as this condition often represents a normal developmental variant in children rather than a pathologic condition. Initial treatment includes activity modification, physical therapy focusing on rotator cuff and periscapular strengthening, and non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief, as suggested by 1. Most pediatric cases are asymptomatic and discovered incidentally, requiring no intervention.
Key Considerations
- If conservative measures fail after 3-6 months in symptomatic cases, surgical options may be considered, though this is rare in the pediatric population.
- Surgery might include either excision of the unfused fragment or open reduction and internal fixation (ORIF) to promote fusion, depending on the size and location of the fragment, as discussed in 2.
- The conservative approach is preferred because the acromion normally develops from multiple ossification centers that typically fuse by late adolescence (around 18-25 years), and premature intervention may disrupt normal development.
- Close monitoring with periodic radiographic evaluation is recommended to assess for potential fusion as the child grows, with surgical intervention reserved only for cases with persistent symptoms that significantly impact function and quality of life, as noted in 3.
Treatment Options
- Nonoperative management, including physical therapy and NSAIDs, should be pursued for at least 6 months before consideration of surgical intervention, as recommended by 4.
- Arthroscopic techniques, such as subacromial decompression, may be considered for symptomatic os acromiale, as described in 5.
- The choice of surgical technique depends on the size and location of the fragment, as well as the presence of any concomitant shoulder pathology, such as rotator cuff tears or subacromial impingement.
Important Considerations for Surgical Intervention
- Surgical intervention should be reserved for cases with persistent symptoms that significantly impact function and quality of life.
- The goal of surgical treatment is to relieve pain, improve function, and prevent further complications, such as rotator cuff tears or subacromial impingement.
- The choice of surgical technique should be individualized based on the specific needs of the patient, as discussed in 1.