Bankart-Bony

• Reported in 5-56% of cases of traumatic anterior shoulder instability(Lynch JR, JSES 2009;18:317).
• Recurrent instability reported in 67% of patients with an inverted-pear glenoid treated with a soft-tissue procedure compared to 4% with a normal glenoid (Burkhart SS, Arthroscopy 2000;16:677).
• Anterior-inferior glenoid defect of 21% of the glenoid length significantly reduces the translational force required for dislocation. Stability decreases progressively with increaseing glenoid defecs. (Itoi E, JBJS 2000;82A:35).
• Lesion of 21% of the glenoid length decreases the intrinsic stability of the glenoid by 50% (Montgomery WH, JBJS 2005;87A:1972).
• Bare spot of the glenoid is equidistant to the anterior, posterior, and inferior glenoid rim. Consider treatment of the glenoid defect if the deficiency is >25% of the diameter of the glenoid. Burkart SS, Arthroscopy 2002;18:488.)

Type I: displaced avulsion fracture

• Small fragment: treatment = excision and Bankart repair vs arthroscopic repair incorporateing the bony Bankart into the repair using suture anchors (Porcellini G, Arthroscopy 2002;18:764)
• Large fragment: treatment = arthroscopic vs open reduction and internal fixation; generally with cannulated screws.

(Bigliani LU, AJSM 1998;26:41)

Type II: malunited avulsion fracture

• Small fragment: treatment = excision and Bankart repair.
• Large fragment: treatment = arthroscopic vs open reduction and internal fixation; generally with cannulated screws.

(Bigliani LU, AJSM 1998;26:41)

Type IIIA: erosion of glenoid; less than 25%

• Treatment = arthroscopic vs open Bankart repair +/- capsular shift.

(Bigliani LU, AJSM 1998;26:41)

Type IIIB: erosion of glenoid; greater then 25%

• Glenoid deficiency greater than 25% generally requires treatment (bone grafting vs coracoid transfer).
• Treatment options
  -Latarjet procedure (Allain J, JBJS 1998;80:841), (Burkart S, AJSM),
  -Tricortical iliac crest great (Warner JJ, AJSM 2006:34:205),
  -Open anterior soft tissue stabilization [large defects loose @7ºER] (Pagnani M, JBJS 2008;36A:1805).

(Bigliani LU, AJSM 1998;26:41)