Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 6, 2021; 9(1): 284-290
Published online Jan 6, 2021. doi: 10.12998/wjcc.v9.i1.284
Simultaneous bilateral acromial base fractures after staged reverse total shoulder arthroplasty: A case report
Du-Han Kim, Beom-Soo Kim, Chul-Hyun Cho
Du-Han Kim, Beom-Soo Kim, Chul-Hyun Cho, Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, South Korea
Author contributions: Cho CH, Kim DH, and Kim BS designed the research study; Cho CH and Kim BS performed the research, contributed new reagents and analytic tools; Kim DH and Cho CH analyzed the data and wrote the manuscript; and all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: the authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chul-Hyun Cho, PhD, Professor, Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, 1035 Dalgubul‑ro, Dalseo‑gu, Daegu 42601, South Korea. oscho5362@dsmc.or.kr
Received: October 9, 2020
Peer-review started: October 9, 2020
First decision: November 20, 2020
Revised: November 21, 2020
Accepted: December 6, 2020
Article in press: December 6, 2020
Published online: January 6, 2021
Processing time: 84 Days and 10.2 Hours
Abstract
BACKGROUND

Acromial and scapular spine fractures after reverse total shoulder arthroplasty (RTSA) are a well-known complication that may negatively impact the effects of long-term outcomes. However, to the best of our knowledge, there has been no report of simultaneous bilateral fractures of the acromion or scapular spine that occurred following staged RTSA.

CASE SUMMARY

A 79-year-old right-handed male visited our outpatient clinic with a chief complaint of pain and limited motion of both shoulder joints for a one-year duration. Based on plain radiographs and magnetic resonance images, the preoperative diagnosis was bilateral cuff tear arthropathy with failed rotator cuff repair. This patient was treated with staged bilateral RTSA at a two-month interval. At 5 and 3 mo after right and left side surgery, the patient returned to the outpatient clinic with severe pain and limited motion of both shoulder joints for 2 wk without a traumatic event. A computed tomography scan revealed non-displaced acromial base fractures of both shoulders. Considering bilateral involvement, fracture location, and patient’s demand, open reduction and internal fixation (ORIF) using plate for bilateral acromial base fractures were performed. At 2 years after ORIF, the fracture was completely healed, and the patient was satisfied with shoulder status.

CONCLUSION

This report describes an extremely rare case of simultaneous bilateral acromial base fractures after staged RTSA managed successfully by ORIF with a pre-contoured plate designed for distal clavicle fractures. Although acromial fracture after RTSA can be treated conservatively, simultaneous bilateral fractures may warrant surgical intervention as a means of addressing difficulties in activities of daily living.

Keywords: Acromion; Fracture; Arthroplasty; Shoulder; Reverse total shoulder arthroplasty; Case report; Complication

Core Tip: Acromial and scapular spine fractures are a well-known complication that can occur by deltoid tension with increased arm length after reverse total shoulder arthroplasty (RTSA). The reported incidences range from 0.6% to 15.8%. However, simultaneous bilateral fractures of the acromion or scapular spine following staged RTSA are extremely rare. Furthermore, its management has not been established. Although acromial fracture after RTSA can be treated conservatively, simultaneous bilateral fractures may warrant surgical intervention as a means of addressing difficulties in activities of daily livings.