Malunions and nonunions of the acromion and coracoid proceses: a comparison of functional outcomes before and after reconstruction
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OBJECTIVES: To assess surgical and functional outcomes in a cohort of patients having operatively reconstructed scapula process malunions and/or nonunions. DESIGN: Retrospective case series. SETTING: Level I trauma center. PATIENTS/PARTICIPANTS: Between 2003 and 2018, we identified 16 patients who presented to our institution with symptoms associated with a nonunion or malunion of closed, displaced fractures of the scapula processes after acute injury mechanisms. INTERVENTION: Surgical osteotomy of the malunion or debridement of the nonunion and subsequent reconstruction. MAIN OUTCOME MEASUREMENTS: The primary outcome measured included range of motion, strength, and DASH. Return to work was a secondary outcome. RESULTS: Among 13 of the 16 (81%) patients with ≥12 months follow-up, the mean follow-up was 34 months (range, 12-112 months). Three patients were lost to follow-up. The mean DASH score improved from 56.4 ± 22.4 preoperatively to 23.4 ± 22.2 postoperatively (P < 0.001). Among the patients with ≥1-year follow-up, range of motion improved from preoperative to final follow-up in abduction (P = 0.020). Among the 15 of 16 patients for whom occupation data are available, 73% either returned to their original occupation (n = 7) or did not due to reasons other than their reconstructive surgery (n = 4). Two postoperative complications occurred including failure of acromion nonunion fixation at 4 months and went on to heal after revision surgery. All reconstructions united without malunion. CONCLUSIONS: Reconstruction of the scapula process malunion and nonunion is possible, providing restoration of function and symptom relief, with a low complication rate. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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