Acromion Fracture Treatment
For displaced acromion fractures (>1 cm displacement), fractures causing subacromial space narrowing, or those with disruption of the superior shoulder suspensory complex, open reduction and internal fixation is the recommended treatment, while minimally displaced fractures can be managed conservatively with immobilization and early rehabilitation. 1, 2
Initial Diagnostic Evaluation
Radiographic imaging is the essential first step for any suspected acromion fracture following shoulder trauma 3:
- Standard shoulder radiographs should include anteroposterior views in internal and external rotation plus an axillary or scapula-Y view 3
- Axillary views are critical as they prevent misclassification of shoulder injuries that can be missed on AP views alone 3
- CT imaging better characterizes fracture patterns when surgical planning is needed 3
- MRI is indicated when concomitant rotator cuff injury is suspected, as this combination significantly affects treatment planning 4
Treatment Algorithm
Conservative Management Indications
Non-displaced or minimally displaced fractures (<1 cm) without associated injuries can be treated non-operatively 1, 2:
- Immobilization in a sling for comfort during the acute phase 1
- Early range-of-motion exercises as pain permits 1
- Progressive strengthening once fracture stability is confirmed 1
Critical caveat: Conservative treatment carries a relatively high non-union rate, though asymptomatic non-unions may not require intervention, particularly in elderly or less active patients 1
Surgical Management Indications
Operative fixation is indicated for 5, 1, 2:
- Displaced fractures with >1 cm of displacement 2
- Fractures causing reduction of the subacromial space 5
- Disruption of the superior shoulder suspensory complex (SSSC) 5, 2
- Concomitant ipsilateral scapula or clavicle fractures 5, 2
- Painful symptomatic non-unions after failed conservative treatment 1, 2
Surgical technique options include 1, 6, 2:
- Open reduction with plate fixation using a postero-superior approach provides stable fixation and allows early rehabilitation 6
- Cannulated screw fixation is an alternative for appropriate fracture patterns 5
- All 27 operatively treated fractures in one case series achieved union with full pain-free motion 2
Special Considerations
Active patients are more likely to require surgical intervention because symptomatic non-unions develop more frequently in this population and significantly limit function 1:
- Surgical fixation in active patients prevents the need for delayed reconstruction of symptomatic non-unions 1
- Early anatomic reconstruction reduces risks of chronic pain, movement restriction, subacromial impingement, and rotator cuff injury 5
Polytrauma patients require heightened vigilance as acromion fractures are frequently missed or diagnosis is delayed when multiple injuries are present 5, 1:
- Systematic evaluation of the entire shoulder girdle is essential 5
- Associated rotator cuff tears must be identified and repaired concurrently if present 4
Postoperative Management
Early rehabilitation is critical for optimal outcomes 6, 2:
- Initiate early range-of-motion exercises of the arm and shoulder 6
- Full range of motion is typically achieved by 6-8 weeks 6
- Radiographic union occurs by 12 weeks in most cases 6
- Hardware removal may be necessary in approximately 10-15% of cases due to prominent hardware irritation 2
Common Pitfalls
Delayed diagnosis in polytrauma settings is the most significant pitfall, as these fractures are easily overlooked when attention is focused on more obvious injuries 5, 1:
- Maintain high index of suspicion for acromion fractures in shoulder trauma patients 5
- Obtain complete radiographic series including axillary views 3
Inadequate assessment of the SSSC can lead to undertreatment, as double disruptions mandate surgical stabilization 2: