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Symptomatic, Unstable Os Acromiale.

S Ashfaq Hasan1, Brian Shiu, Julio J Jauregui

  • 1From the Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD.

The Journal of the American Academy of Orthopaedic Surgeons
|September 11, 2018
PubMed
Summary
This summary is machine-generated.

Management of unstable os acromiale, a missed diagnosis in shoulder pain, involves surgical options like excision or fixation. Treatment choice depends on patient factors and fragment size, with ongoing debate on optimal techniques.

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Area of Science:

  • Orthopedic surgery
  • Shoulder biomechanics
  • Sports medicine

Background:

  • Unstable os acromiale is a challenging diagnosis in patients with shoulder pain.
  • It is often overlooked, necessitating specific evaluation in high-suspicion cases.
  • Current management strategies for symptomatic unstable os acromiale are debated.

Purpose of the Study:

  • To review current surgical management options for persistently symptomatic, unstable os acromiale.
  • To discuss the advantages and disadvantages of different surgical techniques.
  • To highlight patient-specific factors influencing treatment decisions.

Main Methods:

  • Review of surgical options: open/arthroscopic excision, open reduction and internal fixation (ORIF).
  • Analysis of outcomes for different techniques based on fragment size (preacromion, meso-os).
  • Consideration of biomechanical studies and patient factors.

Main Results:

  • Open excision of large fragments yields poor results.
  • Arthroscopic excision is common for small fragments; concerns exist for larger fragments due to potential deltoid weakness.
  • ORIF offers predictable union but may cause symptomatic implants; improved fixation constructs are emerging.

Conclusions:

  • Treatment choice for unstable os acromiale is individualized, based on patient age, activity level, and rotator cuff condition.
  • Optimal fixation constructs may reduce implant-related complications.
  • Further research into biomechanics can refine surgical decision-making.