Stoots Simone J M, Derksen Robert J
Department of Trauma Surgery, Zaandam Medical Center, Kon. Julianaplein 58, 1502 DV Zaandam, Netherlands.
Case Rep Orthop. 2020 Jul 15;2020:9465370. doi: 10.1155/2020/9465370. eCollection 2020.
Acromion fractures are increasingly seen as a postoperative complication following reversed shoulder arthroplasty. However, traumatic fractures of the acromion, usually caused by direct trauma, are rare. Therefore, the current literature lacks standardized clinical guidelines regarding the surgical treatment of these kinds of fractures. We present a traumatic acromion fracture and concomitant distal clavicle fracture, resulting in a so-called "floating acromion." A fifty-four-year-old female patient was presented at the Emergency Department following a fall from the stairs. She complained of severe pain in the left shoulder. Radiographic evaluation of the left shoulder revealed an acromion fracture and concomitant distal clavicle fracture. Initially, since there was no dislocation, this "floating acromion" was treated conservatively. However, after 4 weeks, no improvement in pain was seen and a control CT scan revealed no callus formation. Considering the possibility that this could be a biomechanically unstable injury, together with the persistent severe pain, it was decided to proceed with surgical treatment. A lateral clavicle plate was used to stabilize the acromion fracture. Postoperatively, the patient was provided with a sling. She was regularly seen at the outpatient clinic. After two weeks of circumduction exercises, she was allowed to build up active movement under the supervision of a shoulder physiotherapist. Nevertheless, she developed a frozen shoulder. However, our patient fully recovered with complete restoration of shoulder function. Therefore, for operative management of acromion fractures, we suggest the use of a lateral clavicle plate which fits remarkably well on the lateral spine and acromion.
肩峰骨折越来越被视为反式肩关节置换术后的一种术后并发症。然而，通常由直接创伤引起的肩峰创伤性骨折很少见。因此，目前的文献缺乏关于这类骨折手术治疗的标准化临床指南。我们报告一例创伤性肩峰骨折并伴有锁骨远端骨折，导致所谓的“浮动肩峰”。一名54岁女性患者在从楼梯上摔下后被送往急诊科。她主诉左肩剧痛。左肩的影像学评估显示肩峰骨折并伴有锁骨远端骨折。最初，由于没有脱位，这个“浮动肩峰”采用保守治疗。然而，4周后，疼痛没有改善，CT复查显示没有骨痂形成。考虑到这可能是一种生物力学不稳定损伤，以及持续的剧痛，决定进行手术治疗。使用锁骨外侧钢板来稳定肩峰骨折。术后，给患者使用吊带。她定期在门诊就诊。在进行两周的钟摆运动练习后，允许她在肩部物理治疗师的监督下逐渐进行主动活动。尽管如此，她还是患上了肩周炎。然而，我们的患者完全康复，肩部功能完全恢复。因此，对于肩峰骨折的手术治疗，我们建议使用一种能很好地贴合外侧脊柱和肩峰的锁骨外侧钢板。
