What did the study look at?
Forward instability of the shoulder joint (anterior glenohumeral instability) is challenging to treat, particularly when there is a fracture of the front rim of the socket. This fracture is called an "osseous Bankart lesion". The authors note that successful reduction and fixation of the fragment has been shown to greatly reduce the risk of recurrent dislocation while achieving bone union and restoring the normal shape of the socket.
The article aims to show on video how this repair is performed in a patient with a displaced fracture and substantial pain and instability.
How was it done?
The main steps of the operation are:
- The amount of bone loss is measured on three-dimensional CT reconstructions with the head of the upper arm bone digitally removed.
- The patient lies on their side and the procedure is done arthroscopically (keyhole surgery).
- A diagnostic assessment through posterior and anterior portals checks for rotator cuff injury, the extent of labral tearing and the displacement of the bone fragment.
- The fragment is lifted back into its anatomical position and fixed with a double-row suture technique, followed by capsule and labrum repair.
The authors also describe the non-operative alternative: treatment in a sling can be used provided that CT after reduction shows the humeral head centred on the socket.
What did it find?
This publication does not report new patient results; it summarises expected outcomes from the literature. According to the authors, clinical outcomes after this repair have been reported as highly successful, with high rates of return to sport, minimal loss of motion and restoration of shoulder function and stability. Long-term follow-up has also shown bone union and normalisation of socket anatomy.
The indications the authors cite are young, active patients, a fragment that can be reduced, an anterior glenoid deficit of more than 10% and a history of failed non-operative treatment.
The authors' conclusion
The authors state that osseous Bankart repair has been shown to improve patient-reported outcomes and normalise the shape of the socket. They stress that failing to recognise and properly treat an osseous Bankart fracture may lead to bone erosion from repeated subluxations or dislocations, with substantial pain and weakness.
Limitations
The authors list technical difficulties: reducing the fragment may be harder in chronic cases or with late intervention; suture management can be difficult for surgeons early in the learning curve; and a defect that is wide from medial to lateral may be difficult to work around and reduce.
Reference
Vadhera AS, Knapik DM, Gürsoy S, Dasari SP, Singh H, Verma NN. (2022). Arthroscopic Reduction and Internal Fixation of an Osseous Bankart Lesion. JBJS Essential Surgical Techniques, 12(2), e21.00060. Copyright: © 2022 The Journal of Bone and Joint Surgery, Incorporated.
Free full text: PMC9889287
This article summarises a published scientific paper for general information; it does not replace an examination or a personal medical assessment. Please consult your doctor about your symptoms.
