Case Reports

Arthroscopically-Guided, Cannulated, Headless Compression Screw Fixation of the Symptomatic Os Acromiale

Publish date: September 26, 2018

References

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DISCUSSION

A variety of methods for the management of os acromiale have been described in the literature. Internal fixation is reported as the most common surgical technique, followed by excision and acromioplasty.⁶ Surgical fixation with cannulated screws is effective at achieving radiographic union.⁵^,9,12,13,15

Excision is also an option in cases where there is a symptomatic pre-acromion with a relatively small fragment. In the case of a larger fragment, techniques that preserve the vascularity of the os acromiale appear more likely to be successful than excision.¹⁷ While excision can be performed arthroscopically to preserve the blood supply, a recent report showed that 35% of patients still had residual pain.¹⁸ Another study suggests that protecting the vascular supply with an arthroscopic technique would be a better option to promote healing to union.¹⁹

Given that removal of symptomatic internal fixation hardware is significantly more common after Kirschner wire fixation (88%; 43/49) than after cannulated screw fixation (38%; 9/24),⁶ and given that significant hardware complications can arise from screw tips,¹⁶ we chose headless, cannulated Acutrak compression screws for arthroscopic-assisted fixation. Performing the operation arthroscopically minimized soft-tissue violation, allowing us to directly visualize the reduction and also allowing confirmation that the screws were not at risk for impingement of the rotator cuff. The tapered nature of the Acutrak screws allowed for excellent compression at the reduction site without a prominent screw head.

CONCLUSION

Arthroscopic management of the symptomatic os acromiale has been documented in the literature. Cannulated screw fixation has shown to lead to a higher rate of radiographic union than Kirschner wire fixation. Arthroscopically guided placement of headless, cannulated compression screw fixation may be a viable repair alternative in the management of the symptomatic os acromiale with less concern for symptomatic hardware.⁶^,20-27