TO THE EDITOR:
I read with interest "The Treatment of Symptomatic Os Acromiale" (80-A: 1320—1326, Sept. 1998), by Warner et al.
The article described an operative technique in which wires are passed through two cannulated screws and tied over the top of the acromion to act as a tension band. Because the screws are of a fixed length, it appears to me that the technique of passing the wires through the screws and tying them over the acromion does not, in fact, work as a tension band. The only tension provided is on the fixed-length screws. Perhaps I am missing something, but I do not think that this method creates a tension band.
Peter B. Salamon, M.D.: Alpine Orthopaedic Medical Group, 333 East Alpine Avenue, Stockton, California 95204-3494
Dr. Warner, Dr. Beim, and Dr. Higgins reply:
Dr. Salamon's point is well taken. Technically, the operative construct for repair of an unstable os acromiale is not a tension-band method. The wire that is placed through the screws and over the top of the acromion functions as a tension band only to the extent that the bone deforms around the screws. The construct does, however, offer advantages compared with simple screw fixation across the site of the nonunion. The wires serve to lock the bone down onto the superior surface of the acromion. Thus, it sandwiches the bone graft together with the acromion.
Jon J. P. Warner, M.D.: Harvard Shoulder Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, 275 Cambridge Street, Fourth Floor, Boston, Massachusetts 02114
Gloria M. Beim, M.D.: Hughston Clinic of Colorado, 214 East Denver Avenue, Gunnison, Colorado 81230
Laurence Higgins, M.D.: Duke University Medical Center, Box 3615, Durham, North Carolina 27710