Patient PW was a 48-year-old male triathlete who had bilateral os acromiale, but only the left side was locally symptomatic. The acromion was sensitive on palpitation and after swimming. All impingement signs were negative and the ultrasound and magnetic resonance imaging (MRI) showed marked oedema at the os acromiale but did not reveal any rotator cuff tendinopathy. The patient was first treated with local conservative therapy. This included physical therapy with ice and an infiltration of the os acromial joint with Kenacort and Xylocaine 2%. This gave immediate pain relief for a few hours. Conservative treatment was unsuccessful, meaning that an operation was necessary. In this case, nine screws (2.7- and 3.5-mm) were used. Six anterior angle-stable screws were necessary. Posteriorly two cortical screws (one of which was used for compression) and two angle-stable locking screws were used. Because of the congenital or primary pseudarthrosis, an osteotomy of 1 mm was performed on each side of the osseous non-union including the cranial osteophytes. These bone remnants were pulverized and replaced between or lateral to the plate and the osteotomy site. The control radiography showed correct positioning.
Patient VL was a 28-year-old homeless male. He was admitted to the emergency room after a fall while cycling. He complained of pain in his right shoulder and an impaired range of motion. An X-ray showed a fracture of the acromion and the coracoid process with a slight dislocation of the fragments. This fracture was classified as an S2c fracture according to the lateral scapula suspension system (LSSS) introduced by Lambert et al. (). These fractures together with concomitant ligamentous lesions of the acromioclavicular (AC) ligament caused instability of his shoulder, which made an operation necessary.\nDuring surgery, compression of the fracture was achieved using one cortical and two angle-stable screws. Anterior fixation was achieved using six angle-stable screws (10 or 12 mm). The coracoid fracture was treated percutaneously with a hollow screw as described by Hillewaere and Dierickx (), with the exception that in our case radioscopic rather than arthroscopic monitoring of the reduction was used. After surgery, the patient was advised to stop smoking to avoid impairing the healing process.