A narrative review of acromial and scapular spine fractures complicating reverse total shoulder arthroplasty. It covers diagnosis, classification, aetiology, and management of a fracture spectrum ranging from stress reaction to displaced fracture. The review emphasizes recognition of an underappreciated complication and strategies to prevent it.
When a rTSA patient reports a honeymoon of pain relief followed by acute pain over the acromion or scapular spine, think stress fracture even without trauma. Onset averages 2 to 48 months postoperatively, and point tenderness with limited active elevation is the key exam finding.
Do not be reassured by a negative radiograph. One third of these fractures are invisible on initial films, so proceed to CT or SPECT/CT when clinical suspicion is high. Early diagnosis matters because catching a stress reaction or undisplaced fracture before displacement lets you immobilize and potentially avoid a poor-outcome displaced fracture.
Prevention is the strongest lever: optimize bone health, keep the superior screw around 24 mm angled into the coracoid base, use a short posterior screw to avoid the scapular spine, and avoid over-tensioning the deltoid.
A narrative review of acromial and scapular spine fractures complicating reverse total shoulder arthroplasty. It covers diagnosis, classification, aetiology, and management of a fracture spectrum ranging from stress reaction to displaced fracture. The review emphasizes recognition of an underappreciated complication and strategies to prevent it.
When a rTSA patient reports a honeymoon of pain relief followed by acute pain over the acromion or scapular spine, think stress fracture even without trauma. Onset averages 2 to 48 months postoperatively, and point tenderness with limited active elevation is the key exam finding.
Do not be reassured by a negative radiograph. One third of these fractures are invisible on initial films, so proceed to CT or SPECT/CT when clinical suspicion is high. Early diagnosis matters because catching a stress reaction or undisplaced fracture before displacement lets you immobilize and potentially avoid a poor-outcome displaced fracture.
Prevention is the strongest lever: optimize bone health, keep the superior screw around 24 mm angled into the coracoid base, use a short posterior screw to avoid the scapular spine, and avoid over-tensioning the deltoid.