Reverse Total Shoulder Arthroplasty (RTSA) complications include acromial and scapular spine fractures. There is a scarcity of data on how these fractures respond to treatment. The study aimed to compare the clinical outcomes of individuals with acromial or scapular spine fractures who were treated surgically vs. those who were treated conservatively. Between 1999 and 2016, our institution executed a total of 1,144 RTSAs. In the postoperative course, we found an acromial fracture in 23 patients (2%) and a scapular spine fracture in 7 patients (0.6%). About 7 patients (23%) had open reduction and internal fixation (ORIF), while they managed to remain 23 (77%). The Constant Score (CS), range of mobility, and subjective shoulder value were used to compare surgical versus conservative treatment (SSV). Crosby’s technique was used to classify fractures. Before and shortly after the fracture and after therapy, the radiographic assessment included monitoring the healing rate, healing time, and acromion displacement.

The difference between surgical and conservative treatment was not statistically significant. The mean preoperative CS in the operative group was 32 points before surgery and improved to 45 points after surgery. In contrast, the conservative group’s preoperative CS was 35 points before surgery and improved to 61 points at the final follow-up. The mean SSV increased from 20 to 50 points in the operative group, whereas in the conservative group, it increased from 22 to 58 points. In the surgical group, mean active flexion increased from 59° to 75°, mean abduction decreased from 68° to 67°, and external rotation decreased from 25° to 13°; in the conservative group, mean active flexion increased from 75° to 91°, 67° to 92°, and 28° to 24°. In the study, they did not find surgical treatment superior to conservative treatment in terms of Constant Score, SSV, or range of motion. However, both treatment methods yielded lower results than those previously described for RTSA without postoperative acromion fractures. Conservative treatment of acromial fractures may be the preferred option for acromial fractures after RTSA until better surgical procedures are developed.