Case series of 14 patients (15 shoulders) with painful, unstable os acromiale treated over four years. It reports how location, fixation method, and whether to graft versus excise affect outcome. It compares two tension-band constructs and defines when excision is acceptable.
When a patient has anterior shoulder pain, point tenderness directly over the acromion, and cannot actively flex past 120 degrees, order an axillary radiograph and look for an os acromiale. Most os acromiale are incidental, so confirm it is the pain source. Comparison views or CT showing a unilateral, sclerocystic non-union and bone scan uptake support that it is symptomatic.
The management rule turns on location and fragment size. A small pre-acromion can be excised if you repair the deltoid origin. A meso- or meta-acromion should not be resected, because taking that bone removes the deltoid fulcrum and leaves the patient weak and painful, essentially an acromionectomy.
For those larger unstable fragments, stabilize with bone-grafting and a rigid cannulated-screw tension-band. This paper's main lesson is that pins and wires do not hold, so rigid screw fixation is what produces union.
Case series of 14 patients (15 shoulders) with painful, unstable os acromiale treated over four years. It reports how location, fixation method, and whether to graft versus excise affect outcome. It compares two tension-band constructs and defines when excision is acceptable.
When a patient has anterior shoulder pain, point tenderness directly over the acromion, and cannot actively flex past 120 degrees, order an axillary radiograph and look for an os acromiale. Most os acromiale are incidental, so confirm it is the pain source. Comparison views or CT showing a unilateral, sclerocystic non-union and bone scan uptake support that it is symptomatic.
The management rule turns on location and fragment size. A small pre-acromion can be excised if you repair the deltoid origin. A meso- or meta-acromion should not be resected, because taking that bone removes the deltoid fulcrum and leaves the patient weak and painful, essentially an acromionectomy.
For those larger unstable fragments, stabilize with bone-grafting and a rigid cannulated-screw tension-band. This paper's main lesson is that pins and wires do not hold, so rigid screw fixation is what produces union.