Fig 3.

Right shoulder from a posterior view. (A) An 8-cm incision is made over the lateral acromion in a posterolateral direction followed by soft tissue dissection down to the acromion with a retractor placed (arrowheads). (B) The senior surgeon (P.J.M.) locates the site of nonunion with vertical pressure inferiorly (yellow arrow), which causes gross movement of the distal fragment. (C) The periosteum is sharply dissected with a scalpel (arrowheads), thereby exposing and debriding the edges of the bone and nonunion site (circle). (D) An elevator (arrowheads) is used to lever the anterior part of the acromion into anatomic position. (AAc, anterior acromion; L, lateral; M, medial; PAc, posterior acromion.)