Open Displaced Fracture of Acromion with Associated Complete Supraspinatus Tear: A Rare Case Report.

Introduction: Isolated acromion fractures are rare and in that too, orthopaedicians rarely come across open acromial fractures. Hence literature regarding their management, outcome and any associated complications is obscure. In an extensive search for literature related to our case we found very few articles. We hereby report a case of Gustilo IIIA open acromial fracture with associated supraspinatus, deltoid and capsular injury managed with tension band wiring (TBW) and soft tissue repair with 6 month follow up.

Case Report: A 21-year-old male was admitted in our hospital for wound of right shoulder with pain and inability to move this arm with a history of direct trauma with sharp object 3 days back. On examination, a wound 15 cm in length on the superior aspect of the right shoulder with its depth extending up to the glenohumeral joint was noted. The glenohumeral joint was exposed with a Gustilo Anderson type IIIA acromion fracture and injury of supraspinatus and capsule with no associated vascular or neurological injury. Wound was thoroughly irrigated and was used to approach the fracture site for repair. Capsule of shoulder was carefully closed with absorbable suture followed by suturing of supraspinatus with non-absorbable suture. Our initial plan to fix the acromial fracture to spinous process of scapula with 2 4 mm cannulated cancellous screw placed orthogonal to fracture site was modified intraoperative due to screw cut out and we went ahead with TBW with 1 screw and 1 Kirschner wire to prevent further fragmentation of the fragment. Wound was healing and healthy. Patient was started on a passive pendular exercises after 4 weeks and active exercises at 6 weeks. Six months postoperatively patient had complete range of shoulder rotation with forward flexion of 80° and abduction possible till 45°. Patient was able to do most of his activities of daily living barring overhead activities.

Conclusion: As there are very limited cases of this sort of injury, this case report will cast a light on management options and outcomes of such injuries. We received fair results in our study with good healing and painless functional shoulder joint. However, long term and multi centric studies are required for further information pertaining to such scenarios.