Table 2.

Pearls and Pitfalls

Surgical Steps	Pitfalls	Pearls
Diagnostic arthroscopy	Missing concomitant lesions	Performing a thorough and standardized examination allows for identification of concomitant lesions.
Approach to the os acromiale	Difficulty locating the site of the nonunion	The surgeon should place inferior pressure on the anterior acromion to help identify the distal fragment of the nonunion.
Preparation of nonunion prior to osteosynthesis	Insufficient preparation resulting in postoperative nonunion	The margins of the nonunion can be burred down to a bleeding surface with a motorized rasp to remove fibrous tissue and residual soft tissue, and generate an environment that is enhances healing.
K-wire insertion	Improper drilling through the acromion resulting in penetrating the superior or inferior cortex	Ensure the K-wire is drilled parallel to the acromion. Drill first through the os acromiale and then into the acromion in a retrograde fashion.
Tension-band construct	Insufficient fixation	Crossover of the K-wires during tensioning ensures the loads are evenly distributed across the acromion.
Postoperative rehabilitation	Postoperative stiffness	Early passive range of motion for 4 weeks
		Progression to full passive motion and start of active and active-assisted motion at 4 weeks postoperatively