Acromial Stress Fractures: A Systematic Review

Abstract

Background: Acromial stress fracture (ASF) is a unique complication of reverse shoulder arthroplasty (RSA) that<br />can have substantial influence on clinical results. The purpose of this review is to describe demographics, functional<br />outcomes, and union rates for cases of RSA complicated by ASF.<br />Methods: A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-<br />Analyses (PRISMA) methodology to identify studies that reported results of RSA complicated by ASF. Searches were<br />performed using PubMed and Scopus up to January 1, 2018. Five articles met inclusion and exclusion criteria.<br />Results: ASF occurred in 61 (6.9%) of 874 RSA cases identified. 82% of patients who sustained an ASF were female.<br />ASF cases were, on average, 7 years older than cases that were not complicated by ASF. While improved compared to<br />their preoperative state, patients who sustained an ASF demonstrated significantly less improvement in pain, function,<br />and ROM compared to RSA patients without ASF.<br />Conclusion: Women and older patients appear to be at greater risk for an ASF after RSA. Though nonunion rates are<br />high, fair outcomes can still be achieved in cases of ASF after RSA. Further study is needed to identify modifiable and<br />non-modifiable risk factors associated with the development of ASF.<br />Level of evidence: IV