Traumatic posterior dislocation of the shoulder with fracture of the acromion in a child

Diagnosis and Treatment of Scapular Fractures in Children and Adolescents: A Critical Analysis Review

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Fractures of the growing scapula account for about 0.1% of all pediatric fractures, with the majority occurring at an age of ≥10 years.

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Radiographic diagnosis requires a detailed knowledge of the ossification sequence of the growing scapula. Computed tomography examination is indicated for displaced fractures of the glenoid fossa, the scapular neck, and complex fractures; magnetic resonance imaging should be performed in cases of suspected injury to the physis and with stress fractures, depending on patient age and the potential need for general anesthesia during the scanning process.

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Separation of the base of the coracoid process is often associated with acromioclavicular dislocation. Clavicular fractures rarely occur in combination with injuries to the growing scapula.

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The majority of scapular fractures can be treated nonoperatively. Indications for surgery are displaced intra-articular fractures, scapular neck fractures with a displacement of >2 cm, coracoid base separation associated with acromioclavicular dislocation, and scapulothoracic dissociation.

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Displaced intra-articular fractures of the glenoid fossa should be followed after healing until skeletal maturity. Complications are rare and occur most frequently with scapulothoracic dissociation.

Arthroscopic treatment of post-traumatic shoulder instability in children and adolescents

Traumatic dislocation of the shoulder in childhood is rare, accounting for only 0.01% of all injuries in this age class. However, the literature does contain indications that post-traumatic instabilities and redislocations occur with more than average frequency in children and adolescents. This study describes the technique and results of arthroscopic stabilization of the shoulder joint before the completion of growth. Over a period of 4 years, seven patients were treated prior to reaching skeletal maturity. Five patients were treated by means of arthroscopically assisted labral refixation using suture anchor systems. Clinical follow-up was undertaken after between 6 and 48 months using a modified Constant-Murley score. Instabilities, re-dislocations and postoperative impairment of mobility did not occur after arthroscopic treatment, with a score of 92 points. Arthroscopic labral refixation is a reliable, surgical treatment procedure for post-traumatic shoulder instability in adults. This study showed that it can be used successfully in children and young people prior to skeletal maturity. No alteration of the surgical procedure of Bankart repair in adults is necessary. Considerable experience in adult shoulder reconstruction promises excellent results in children and adolescents, too. There is no evidence of growth disturbance or biodegradation associated problems in this group of children and adolescents. Delay of labral refixation until adulthood is therefore not indicated.

Open reduction internal fixation after displacement of a previously nondisplaced acromial fracture in a multiply injured patient: case report and review of literature

SUMMARY

A twenty-eight-year-old multiple trauma patient had a nondisplaced acromion fracture that was not detected until after it had displaced. Open reduction internal fixation was performed without complication and the patient achieved excellent shoulder abduction strength. Nondisplaced acromion fractures may displace if not protected. Open reduction internal fixation of displaced acromion fractures should be considered if deltoid muscle strength is important to the patient.