Os acromiale open reduction and internal fixation: a review of iliac crest autogenous bone grafting and local bone grafting.

BACKGROUND: Symptomatic os acromiale are fairly uncommon, and treatment has included fragment excision, decompression, and open reduction and internal fixation. Nonunion rates as high as 40% have been reported after fixation of os acromiale. This study assessed whether union of an os acromiale could be reliably achieved without the use of an iliac crest bone graft. METHODS: This was a retrospective study of 32 consecutive shoulders that were treated with screw fixation and a local bone graft or iliac crest bone graft. The mean age was 50.3 years (range, 21-74 years), and the mean follow-up was 46.9 months (range, 12-120 months). Fusion was assessed clinically and radiologically. RESULTS: All 32 os acromiale were fused by 3 months on x-ray imaging. There were 18 shoulders in the iliac crest bone graft group and 14 in the local bone graft group. Rotator cuff repairs were performed concomitantly in 25 patients. Hardware was removed in 4 patients, a seroma was drained in 1 patient, and a superficial infection occurred in 1 patient. CONCLUSION: This is the largest study of os acromiale fixation using screws and a tension band to our knowledge. We report a 100% union rate using this technique, with 13% requiring hardware removal and the occurrence of 1 superficial infection. This study shows a local bone graft is as effective as iliac crest bone graft in achieving fusion.

The inter-teres approach to glenoid neck fractures: an alternative approach to glenoid fixation.

BACKGROUND: Scapula fractures are rare injuries that are generally treated nonoperatively. When surgery is performed, it is commonly undertaken through the posterior approach, which can be invasive and unforgiving on the soft tissues. We describe an alternative safe approach between teres major and minor that remains deep to a fascial sling formed by the combined infraspinatus and teres minor fasciae and deep to the primary nerve to teres minor, which is a terminal branch of the axillary nerve. METHODS: Between January 2008 and June 2014, there were 22 patients who underwent scapula fixation with this approach who were retrospectively identified and prospectively invited for clinical review by the American Shoulder and Elbow Surgeons (ASES) evaluation form and Constant score. Postoperative external rotation (ER) power in both abduction and adduction was also assessed. RESULTS: Five patients were lost to follow-up. All of the remaining patients were male with a mean age of 44.5 years (28-66 years). Mean follow-up time was 34.7 months (3-72 months). The mean ASES score for the 17 patients was 86.6 (41.6-100); the mean Constant score was 89.3 (22-100). The only significant factor affecting the ASES score was an ipsilateral neurologic upper limb injury. ER power was improved or equivalent to the contralateral side in 8 of the 10 patients assessed for ER; it was weaker in 2 patients, both of whom had surgical fixation of the vertebral border of the scapula. CONCLUSION: The inter-teres approach may be a safe alternative approach in glenoid fixation, although the loss of ER strength needs further evaluation.