Musculoskeletal Plain Film Series

15 yr old with history of trauma

1. How do we read the radiograph?

There is evidence of mild increase in the humero-acromial width on the right as compared to the left

Acromion on the right is ill-defined and stippled with loss of outer marginal definition. Glenohumeral and acromioclavicular articulations and rest of the study is  normal

2. Is this  a  fracture?

This case is complex in that it shows stippling and not bilaterally symmetrical  as well as there is sublte  width increase  an may be possibly periosteal response of the mid humeral shaft

3. why not os acromiale ?

Good question

Os acromiale is present in about 15% of population

Acromion arises by 2 -3 separate ossification centers between 14 to 16 years and coalesce by 19 years with each other and join the main bone by 20-25 years

The catch in this is- it is invariably bilateral and in our case only the right acromion is stippled and asymmetrical

4. How do we report ?

I would be concerned about the duration of trauma and if it is more than 6-7 days , findings of increased width, humeral shaft response and irregular acromion would go in favour of acute osteomyelitis

5. In this case what happened?

The history in this case is fall few days ago and and I am inclined to go in for the infection superimposed on haematoma

6. What should be radiology follow up?

Academically MRI would solve all the problems .it will show marrow edema, soft tissues, fluid in the joint, and show  true nature of acromion finding

7. Is there any other way?

 One needs to treat it as infection  after blood tests, Chest Xray (as the infections are possibly staphyloccus)  and review x ray after 3 weeks would give true picture