Internal fixation of symptomatic os acromiale: a series of twenty-six cases

Twenty-six patients who presented to our shoulder service with a symptomatic meso-os acromiale were reviewed. All had been initially treated for impingement symptoms. Nonoperative treatment had failed in all patients. One patient had also undergone an arthroscopic acromioplasty without benefit. The diagnosis of symptomatic os acromiale was made on the basis of radiographs and point tenderness over the acromion coupled with signs of rotator cuff pathology. We assessed these patients after treatment by internal fixation and bone grafting. Fixation was achieved with either K-wires or screws and tension banding with either wire or suture. Fifteen patients had associated rotator cuff tears. The clinical and radiologic results are reported. The rate of union was 96% (25/26), and 24 of 26 patients (92%) were satisfied with their results. The mean time to union was 4 months. There were two postoperative fractures. Eight patients (thirty-one percent) had postoperative pain that was subsequently relieved by wire or screw removal. Seventeen patients had concomitant rotator cuff tears. Eleven cuff tears were repaired, and six were irreparable. One of these six was extensively debrided. We conclude that open reduction-internal fixation of the symptomatic meso-acromion yields satisfactory results, and with the exception of hardware discomfort necessitating removal, minimal complications arise in the majority of cases.