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Case of minimally displaced acromion fracture treated conservatively with shoulder spica

Author: 
Dr. Abhishek A Nerurkar, Dr. Mishil S. Parikh and Dr. Arvind B. Goregaonkar
Subject Area: 
Health Sciences
Abstract: 

Scapular fractures generally result after high energy trauma. Approximately 8 – 9 % of scapular fractures involve the acromial spine. Historically scapular fractures have been treated non operatively due to limited knowledge about the surgical procedures and fixation devices. Thus majority of acromial spine fracture have been under treated and the complications have been accepted. We have reported a 49 year old male patient with minimally displaced acromion spine fracture, without reduction of the subacromial space. This fracture can be classified as type 1 fracture as per Kuhns Classification for which conservative treatment is recommended. We have treated this patient with a shoulder spica cast after closed reduction of the acromial spine fracture under image intensifier guidance. Serial X rays were done every week to check for displacement. Cast was continued for 4 weeks and shoulder mobilization was started thereafter. After 3 months, patient has good functional range of movement and strength at shoulder joint (UCLA Scale 33/35). There was no evidence of displacement of fracture after 3 months. The guidelines in literature for the treatment of undisplaced and minimally displaced fractures are controversial and there are no factors to predict the delayed displacement of such fractures. Thus we conclude that every acromion spine fracture should be protected to prevent further displacement, to provide a good functional outcome and to avoid the requirement of delayed surgical procedure.

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