Acromial fracture: A complication of arthroscopic subacromial decompression

For many surgeons arthroscopic subacromial decompression has replaced open surgery for the treatment of refractory impingement syndrome. A newly recognized complication of this procedure is fracture of the acromion process. Six patients presented with reports of increasing postoperative shoulder pain, commonly with a history of sudden onset during physical therapy. Diagnosis was frequently delayed; three of the six fractures were identifiable only on axillary radiographs. Disability varied from mild pain to severe functional impairment, depending on fracture size and location. Treatment modalities ranged from total acromionecfomy to conservative measures; most results were poor. These cases suggest that: (1) risk factors for experiencing an acromial fracture include osteopenia and overzealous bone resection; (2) surgical correction of the fracture may not satisfactorily resolve associated pain and loss of range of motion; and (3) emphasis on appropriate preoperative planning and meticulous surgical technique to minimize bony resection may decrease the risk of this compficafion and its resultant disability.