PMC6614114_01
Left shoulder x-rays. a) AP view, yellow arrow: displaced fracture of lateral angle of the scapular spine; b) outlet view, red arrow: displaced acromion fracture; c) axillary view, yellow and red arrows: the same as figure a and b; CL- clavicle; AA- anterior acromion; DF- displaced fragment; SS- spine of the scapula; ACJ- acromioclavicular joint.
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Simple radiographs of the shoulder (series trauma) were performed in AP, profile and axillary profile (Fig. 1), in initial consultation at the medical center.
Left shoulder CT (a) with 3D reconstruction (b). yellow arrow: displaced fracture of lateral angle of the scapular spine; red arrow: displaced acromion fracture; black arrow: acromioclavicular joint; CL- clavicle; DF- displaced fragment; SS- spine of the scapula.
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A computerized tomography scan of the shoulder with three-dimensional reconstruction (Fig. 2) was requested, however the diagnosis was only confirmed 37 days after the trauma, due to delayed patient return with the exam results: deviated fractures of acromion (Ogawa-1; Hunt-3; AO-A1) and lateral angle of the spine of the scapula (Ogawa 3; Hunt 3).
Surgical Procedure: a) intra-operative displaced fractures image; b) open reduction of both fractures, yellow arrow: displaced fracture of lateral angle of the scapular spine; blue arrow: displaced acromion fracture; c) osteosynthesis of both fractures with blocked plate and screws + steimann wires (black arrow); AA- anterior acromion; SS- spine of the scapula; DF- displaced fragment.
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It was noticed that there was a complete chronic rupture of the associated rotator cuff (Fig. 3).
Intraoperative rotator cuff tear (yellow arrow). AA- anterior acromion; SS- spine of the scapula; DF- displaced fragment; SST- supraspinatus tendon.
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The fracture of the lateral angle of spine of the scapula was fixed with locked plate of mini-fragments with four cortical screws, while the fracture of acromion with two Steinmann yarns 2.0, from posterior to anterior, because of the fragility of the bone and risk of posterior fragment split (Fig. 4).
Post-operative left shoulder x-rays. a) AP view (immediate P.O.); b) outlet view, red arrow: acromion fracture after removal of osteosynthesis material.
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A radiograph in AP on post-surgery was made (Fig. 5a). Following the surgical procedure, periodic radiographic examinations were performed to follow the bone healing of the fractures (Fig. 5b).