PMC5996414_01
Anteroposterior plain film radiographs of the patient's left shoulder. Bony fragment off the anterior glenoid preoperative indicated by arrow (a). Successful anatomical reduction of the bony fragment four months postoperative (b).
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Plain film radiography revealed a 1 cm thin fragment of bone off the anterior glenoid, indicative of a bony Bankart (Figure 1(a)). Plain film imaging four months postoperative indicated anatomic reduction of the fragment (Figure 1(b)).
Axial T1 weighted MRI shoulder slice of the left shoulder with an arrow pointing to the everted fragment.
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Magnetic resonance imaging (MRI) confirmed this, but on critical examination of axial cuts, the fragment appeared flipped with subchondral bone superficial to articular cartilage (Figure 2).
Intraoperative images of the left shoulder from the anterior high rotator interval portal. Bony fragment with subchondral bone superficial and articular cartilage deep (a). Reduction of fragment with grasper (b). Fragment anatomically reduced and fixed in place with suture anchors (c). Capsular layer repaired over the top of the fragment and fixed to intact glenoid utilizing knotless anchors (d). Humeral head abrasion is apparent in all images.
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A thin bony fragment with the articular surface deep and the bony surface superficial was present (Figures 3(a) and 3(b)). Both articular cartilage abrasion (Figure 3), possibly from articulating with the exposed subchondral fragment, and a small Hill-Sachs lesion were present on the humeral head. The fragment was fixed using a double row technique as described by Millet and Braun using three Arthrex PushLock 2.9 mm anchors (Arthrex, United States) and #2 FiberWire suture (Arthrex, United States) (Figures 3(c) and 4). The capsule was then advanced over the top of the fragment using three additional PushLock anchors (Figure 3(d)).