Fracture Care · Shoulder & arm
Acromion fracture after reverse shoulder replacement
Acromion or Scapular Spine Fracture After Reverse Shoulder Replacement — Open Reduction and Internal Fixation (ORIF)
The condition
After a reverse shoulder replacement, the large deltoid muscle does the work of lifting the arm. It pulls on the acromion—the bony roof at the top of the shoulder blade—and the scapular spine behind it. These can crack, with or without a fall, causing pain at the top of the shoulder and sudden trouble lifting the arm.
The surgery
Through an incision over the top and back of the shoulder, the broken bone is lined up and held with one or two plates and screws; bone graft may be added. Your shoulder replacement itself is not changed. Because the deltoid pulls across the repair, the arm is protected for several weeks while the bone heals. The final plan is determined during surgery.
Recovery at a glance
- Sling
- Worn full time for 6 weeks (8 if the repair needs extra protection), off only for hygiene and exercises. Your therapist gently moves the arm for you.
- Daily life
- Elbow, wrist, and hand motion right away. No lifting the arm on your own, lifting objects, pushing up from a chair, or leaning on the arm for 6 weeks. No driving while taking narcotic pain medication.
- Motion & lifting
- Once x-rays show healing, the sling is weaned over 1–2 weeks and lifting 1–2 lb begins. Lifting the arm on your own starts ~8 weeks, below shoulder height first.
- Activity
- Lifting up to 5 lb until 4 months; avoid heavy or repeated overhead lifting long term. Full release typically 4–6 months; expect less motion and strength than before the fracture.
A general guide. Your restrictions and timeline may change based on what is found and done at surgery.
Risks & benefits
Benefits: Healing the acromion restores the deltoid's anchor so your reverse shoulder can lift the arm again. Risks are uncommon and include infection, blood clots, the bone not healing (more common than with most fractures), a new fracture nearby, infection of the shoulder replacement, hardware irritation that may require removal, shoulder instability, less motion and strength than before the fracture, injury to nearby structures (such as nerves or blood vessels), stiffness, persistent pain, and the need for further surgery. These will be reviewed with you in detail before surgery.
Patient Surgical Information
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