BACKGROUND: The acromion projects laterally in a curving orientation. When a fracture of the acromion occurs, despite being rare, matching the best-fit fixation plate is challenging due to few options and limited availability of fixation plate types. Alternative fixation methods can carry risk of nonunion complications. PURPOSE: The objective of this study was to investigate the morphological curvature pattern of the acromion to assess the level of the fixation plates fitness and provide the suitable imaging modalities for evaluating the acromion curvature. BASIC PROCEDURES: The correlation between the acromion curvature and five fixation plates were calculated and their fitness level was evaluated statistically. The curvature of acromion and the five available fixation plates were photographed and assessed digitally by software (FIJI ImageJ and Microsoft Excel). The method entails plotting seven points along the curving surface and margins of the acromion, while the Excel Solver function calculates the regression, ultimately giving curvature values. First, the acromion parameters were studied on 180 paired healthy dry scapulae. Then, the acromion curvature values were compared to the fixation plates curvatures. Likewise, the acromion curvature was assessed as applicable on 153 (100 AP- views, 50 Y- views, and 3 superior-views) retrospective plain X-rays and 40 3D-CT scapula reconstructions of healthy acromia. MAIN FINDINGS: The mean length of the acromion was 48.70 ± 5.29 mm, mean thickness was 8.51 ± 1.67 mm, and mean width was 25.97 ± 5.97 mm. The calculated values of the mean curvatures were 0.050 ± 0.015 mm-1 for the mean acromion surface, 0.042 ± 0.027 mm-1 for the internal margin, and 0.055 ± 0.010 mm-1 for the external margin. The curved geometry of the acromion was plotted on a graph giving a spectrum of curvature patterns with distribution values revealing fixation plates fitness represented by area under the curve with frequencies of 4.32 % for the acromion-specific fixation plate, 14.28 % for the large clavicle fixation plate, 0.26 % for the small clavicle fixation plate, 53.38 % for the flexible universal fixation plate, and none for the rigid universal fixation plate. PRINCIPAL CONCLUSIONS: Approximately 27.76 % of the acromion surface curvatures distribution does not overlap with any of our measured fixation plates. Evaluating the acromion surface curvature was possible on plain X-rays in the Y-view only.

Department of Anatomy 2nd Faculty of Medicine Charles University Prague Czech Republic; Center for Endoscopic Surgical and Clinical Anatomy 2nd Faculty of Medicine Charles University Prague Czech Republic

Department of Anatomy 2nd Faculty of Medicine Charles University Prague Czech Republic; Center for Endoscopic Surgical and Clinical Anatomy 2nd Faculty of Medicine Charles University Prague Czech Republic; Department of Orthopaedics and Traumatology 2nd Faculty of Medicine Charles University and Motol University Hospital Prague Czech Republic

Department of Orthopaedics and Traumatology 2nd Faculty of Medicine Charles University and Motol University Hospital Prague Czech Republic

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