The distal acromial tip fusion: a novel procedure to mitigate acromial stress fractures in high-risk patients undergoing reverse shoulder arthroplasty.

Acromion and scapular spine fractures (ASFs) pose significant challenges in the management of patients undergoing reverse total shoulder arthroplasty and there is a pressing need for effective preventive measures. Current predictive factors for ASF include female sex, osteoporosis, older age, and anatomical considerations such as glenoid medialization and acromial morphology. However, surgical options to mitigate ASF risk are limited. In this study, we propose a novel technique: incorporation of distal acromial tip fusion (DATF) during primary reverse total shoulder arthroplasty procedures. DATF involves bony fusion between the undersurface of the anterolateral acromion and the region where the superior rim of the glenoid meets the lateral base of the coracoid using a strut graft. The primary objective is to reinforce the anterior acromion process, thereby enhancing shoulder suspensory complex rigidity and theoretically reducing ASF risk. The technique involves precise positioning and exposure, graft preparation, and fixation. While DATF shows promise in ASF prevention, further biomechanical and clinical data are needed to validate its efficacy and safety. Nevertheless, in patients with a high risk of ASF, DATF may offer a viable prophylactic intervention alongside existing management strategies.