Simultaneous bilateral acromial base fractures after staged reverse total shoulder arthroplasty: A case report

BACKGROUND Acromial and scapular spine fractures after reverse total shoulder arthroplasty(RTSA)are a well-known complication that may negatively impact the effects of long-term outcomes.However,to the best of our knowledge,there has been no report of simultaneous bilateral fractures of the acromion or scapular spine that occurred following staged RTSA.CASE SUMMARY A 79-year-old right-handed male visited our outpatient clinic with a chief complaint of pain and limited motion of both shoulder joints for a one-year duration.Based on plain radiographs and magnetic resonance images,the preoperative diagnosis was bilateral cuff tear arthropathy with failed rotator cuff repair.This patient was treated with staged bilateral RTSA at a two-month interval.At 5 and 3 mo after right and left side surgery,the patient returned to the outpatient clinic with severe pain and limited motion of both shoulder joints for 2 wk without a traumatic event.A computed tomography scan revealed nondisplaced acromial base fractures of both shoulders.Considering bilateral involvement,fracture location,and patient’s demand,open reduction and internal fixation(ORIF)using plate for bilateral acromial base fractures were performed.At 2 years after ORIF,the fracture was completely healed,and the patient was satisfied with shoulder status.CONCLUSION This report describes an extremely rare case of simultaneous bilateral acromial base fractures after staged RTSA managed successfully by ORIF with a precontoured plate designed for distal clavicle fractures.Although acromial fracture after RTSA can be treated conservatively,simultaneous bilateral fractures may warrant surgical intervention as a means of addressing difficulties in activities of daily living.

Return to work following shoulder arthroplasty:A systematic review

BACKGROUND Many patients prioritize the ability to return to work(RTW)after shoulder replacement surgeries such as total shoulder arthroplasty(TSA),reverse TSA(rTSA),and shoulder hemiarthroplasty(HA).Due to satisfactory clinical and functional long-term outcomes,the number of shoulder replacements performed will continue to rise into this next decade.With younger individuals who compose a significant amount of the workforce receiving shoulder replacements,patients will begin to place a higher priority on their ability to RTW following shoulder arthroplasty.AIM To summarize RTW outcomes following TSA,rTSA,and HA,and analyze the effects of workers’compensation status on RTW rates and ability.METHODS This systematic review and analysis was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.A literature search regarding RTW following shoulder arthroplasty was performed using four databases(PubMed,Scopus,Embase,and Cochrane Library),and the Reference Citation Analysis(https://www.referencecitationanalysis.com/).All studies in English relevant to shoulder arthroplasty and RTW through January 2021 that had a level of evidence I to IV were included.Nonclinical studies,literature reviews,case reports,and those not reporting on RTW after shoulder arthroplasty were excluded.RESULTS The majority of patients undergoing TSA,rTSA,or HA were able to RTW betweenone to four months,depending on work demand stratification.While sedentary or light demand jobs generally have higher rates of RTW,moderate or heavy demand jobs tend to have poorer rates of return.The rates of RTW following TSA(71%-93%)were consistently higher than those reported for HA(69%-82%)and rTSA(56%-65%).Furthermore,workers’compensation status negatively influenced clinical outcomes following shoulder arthroplasty.Through a pooled means analysis,we proposed guidelines for the average time to RTW after TSA,rTSA,and HA.For TSA,rTSA,and HA,the average time to RTW regardless of work demand stratification was 1.93±3.74 mo,2.3±2.4 mo,and 2.29±3.66 mo,respectively.CONCLUSION The majority of patients are able to RTW following shoulder arthroplasty.Understanding outcomes for rates of RTW following shoulder arthroplasty would assist in managing expectations in clinical practice.