Pediatric Bony Bankart Fracture
Bony Bankart lesions are avulsion fractures of the glenoid rim that occur during traumatic dislocation of the glenohumeral joint. The incidence of anterior glenoid rim fractures associated with anterior dislocation ranges from 5.4% to 44%. Initial management of a shoulder dislocation is closed reduction and immobilization. Due to risk for recurrent shoulder instability when treated conservatively, bony Bankart fractures should be treated surgically in patients who are medically stable and able to comply with postoperative protocols. When X-rays are concerning for a bony Bankart lesion, advanced imaging should be obtained after reduction to evaluate the size and quality of the bony lesion. Size of the lesion and bone quality will determine treatment type. Large fragments (>25%) may undergo open or arthroscopic reduction and fixation with cannulated screws. Smaller fragments (<25%) may undergo open or arthroscopic Bankart repair using suture anchors. Many of these lesions are discovered in the setting of recurrent instability after a period of failed conservative treatment. With repeated episodes of instability, there is increased risk of bone loss which may affect treatment options. When >20% bone loss has occurred, a bony block procedure such as Latarjet is indicated. When surgical treatment is performed early after a single episode of instability, recurrence rates are lower than those treated after episodes of recurrent instability. Arthroscopic treatment is equally effective as open treatment in terms of recurrence.