Os Acromiale: Clinical Management and Surgical Techniques

Os acromiale arises from a failure of fusion between the acromial ossification centres, resulting in one or more mobile bone fragments at the acromion. The condition affects up to 15 per cent of the population and often presents with shoulder pain, impingement and reduced range of motion. Diagnosis hinges on careful clinical evaluation supplemented by radiography, MRI or CT to distinguish os acromiale from other acromial pathologies. Initial management is conservative, encompassing physiotherapy, non-steroidal anti-inflammatory drugs and targeted injections. Surgical intervention is reserved for cases refractory to nonoperative measures or complicated by rotator cuff pathology. Established operative options include open reduction and internal fixation using tension band wiring, fragment excision with deltoid repair and acromioplasty. Recent advances have shifted towards minimally invasive approaches: patient-specific pre-bent osteosynthesis plates fashioned from three-dimensional printed models enable precise fragment realignment, while arthroscopic techniques facilitate both fixation and concurrent treatment of concomitant pathology. Emerging suture-based constructs, such as double-button systems, permit stable compression of fragments with minimal soft-tissue disruption. Overall, tailored surgical strategy guided by fragment size, anatomical configuration and patient demands achieves high rates of union, symptom relief and functional restoration.

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Technical terms

Os acromiale: A developmental nonunion of one or more acromion ossification centres producing a mobile acromial fragment.

Tension band technique: A fixation method converting tensile forces across a nonunion into compressive forces to promote bone healing.

Osteosynthesis plate: A rigid metallic device used to stabilise bone fragments during internal fixation.

Three-dimensional printed model: A patient-specific anatomical replica created from imaging data to guide preoperative implant design.

Double-button fixation: A suture-based construct employing paired buttons to compress and stabilise bone fragments in a minimally invasive manner.

Arthroscopic technique: A minimally invasive surgical approach using an endoscope and specialised instruments to visualise and treat intra-articular or peri-articular pathology.

References

1. Os Acromiale: Reviews and Current Perspectives. Orthopaedic Surgery (2019).
2. Prebending of osteosynthesis plate using 3D printed models to treat symptomatic os acromiale and acromial fracture. Journal of Experimental Orthopaedics (2017).
3. Arthroscopic Fixation of Symptomatic Meso‐Type Os Acromiale: Technical Note. Case Reports in Orthopedics (2022).
4. Surgical treatment of a symptomatic os acromiale by arthroscopy-assisted double-button fixation: a case report. Archives of Orthopaedic and Trauma Surgery (2022).
5. Clinical results and complications following surgical management of symptomatic os acromiale: a systematic review. Journal of Orthopaedic Surgery and Research (2019).