ArticleJournal of shoulder and elbow arthroplasty2026
Risk factors for acromial stress fractures following primary reverse total shoulder arthroplasty: the impact of prior acromioplasty and radiographic parameters.
Article in Journal of shoulder and elbow arthroplasty, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Hypothesis/Background: Acromial scapular stress fractures (ASFs) are a complication after primary reverse total shoulder arthroplasty (rTSA), often causing functional impairment. The role of acromioplasty and radiographic predictors in ASF is unclear. Prior acromioplasty, acromial thickness (AT), deltoid tuberosity index (DTI), and changes in critical shoulder angle (ΔCSA) may influence ASF development. Methods: A retrospective analysis of 698 patients who underwent primary rTSA from 2017 to 2022 with a minimum 2-year follow-up was carried out. ASF were confirmed by CT and classified according to Levy et al. Demographic, surgical, and radiographic data-AT, DTI, critical shoulder angle, ΔCSA, lateralization shoulder angle, and distalization shoulder angle-were collected. Data were analyzed using Firths penalized logistic regression. Results: ASF occurred in 36 patients (5.2%), (52.8% Type I, 41.6% Type II, and 5.6% Type III). Prior acromioplasty was more frequent in ASF patients (30.6% vs. 15%, Conclusion: Reduced DTI and greater ΔCSA are significant independent predictors of ASF after primary rTSA. Preoperative assessment DTI and careful management of critical shoulder angle may help identify high-risk patients and mitigate the incidence of ASF.
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