Reconstruction of Complex Acromion Nonunions and Fractures With a Locking Mesh Plate

Objectives: To assess surgical and functional outcomes in a cohort of patients having surgically reconstructed acromion nonunions or severely comminuted acute fracture patterns treated with a variable angle, locking mesh plate with a matrix of screw options. Design: Retrospective case series. Setting: Level I trauma center. Patients: Between 2012 and 2017, 10 patients, 4 patients with acromion nonunions and 6 patients with severely comminuted acromion fractures presented to a single institution and underwent surgical treatment. Intervention: Surgical repair of complex acromion fractures and nonunions utilizing a 2.4/2.7 locking mesh plate (Depuy-Synthes) with bone grafting (nonunions). Main Outcome Measurements: Primary outcome measures include range of motion; strength; Disabilities of the Arm, Shoulder, and Hand; and Short Form 36 Health Survey. Results: Seven of 10 patients (70%) achieved 1 year follow-up, mean 23.3 months (range, 12 to 46 mo). Nine of 10 patients achieved union following the index reconstruction procedure and 1 patient achieved union after revision of failed mesh plate fixation. At final follow-up, the mean Disabilities of the Arm, Shoulder, and Hand score was 20.0 (11.2 in fracture group and 31.6 in nonunion group) and mean mental and physical component Short Form 36 scores were 51.4 and 42.9, respectively. Conclusions: A variable angle, locking mesh plate may be a useful implant choice for complex nonunions and severely comminuted fracture patterns of the acromion process. In this series, union rate and perioperative complications were acceptable in extreme fracture variants.