Is Acromial Fracture after Reverse Total Shoulder Arthroplasty a Negligible Complication?: A Systematic Review
10.4055/cios.2019.11.4.427
- Author:
Chul Hyun CHO
1
;
Jae Won JUNG
;
Sang Soo NA
;
Ki Cheor BAE
;
Kyung Jae LEE
;
Du Han KIM
Author Information
1. Department of Orthopedic Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea. osmdkdh@gmail.com
- Publication Type:Randomized Controlled Trial
- Keywords:
Reverse shoulder arthroplasty;
Acromion;
Scapular;
Fracture;
Systematic review
- MeSH:
Acromion;
Arthroplasty;
Diagnosis;
Elbow;
Follow-Up Studies;
Humans;
Humerus;
Incidence;
Prognosis;
Prospective Studies;
Prosthesis Design;
Research Personnel;
Shoulder;
Surgeons;
Visual Analog Scale
- From:Clinics in Orthopedic Surgery
2019;11(4):427-435
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: The purpose of this study was to investigate the incidence of acromial fracture after reverse total shoulder arthroplasty (RTSA) and clinical and radiological outcomes of treatment of the fracture. METHODS: A systematic review was performed to identify studies that reported the results of treatment of acromial fractures after RTSA. A literature search was conducted by two investigators using four databases (PubMed, Embase, Cochrane, and Ovid Medline). RESULTS: Fifteen studies (2,857 shoulders) satisfied our inclusion criteria. The incidence of acromial fracture after RTSA was 4.0% (114 / 2,857). The mean age of the patients at the time of fracture was 72.9 years (range, 51 to 91 years). The mean time from RTSA to diagnosis of acromial fracture was 9.4 months (range, 1 to 94 months). One hundred shoulders (87.7%) were treated conservatively and 14 shoulders (12.3%) were treated surgically. The mean follow-up period after acromial fracture was 33.8 months. The overall union rate was 50.0% (43.8% for conservative treatment and 87.5% for operative treatment). The fracture incidence was significantly different among the medial glenoid and medial humerus prosthesis design (8.4%), the lateral glenoid and medial humerus design (4.0%), and the medial glenoid and lateral humerus design (2.8%). The mean values at final follow-up were as follows: visual analog scale score, 2.2; American Shoulder and Elbow Surgeons score, 59.1; Constant score, 59.7; and Simple Shoulder Test, 5.8. The mean forward flexion, abduction, and external rotation were 102.3°, 92.3°, and 25.8°, respectively. CONCLUSIONS: Acromial fractures after RTSA are a complication neither uncommon nor negligible. In the absence of studies with high-level evidence, there is a controversy on the outcomes after treatment. Further well-designed prospective randomized controlled studies with a long-term follow-up should be performed to ascertain the diagnosis, treatment, and prognosis of acromial fractures after RTSA.
