By Dr Terry Hammond
MBBS FRACS Orth
A 17 year old boy presents with recurrent shoulder dislocations. His initial injury was a tackle at rugby at the age of 15. He required reduction under sedation in the Emergency Department. Since then he has had 10 further dislocations with two of these occurring in his sleep. The shoulder feels very unstable in full abduction and external rotation with his arm above his head. Clinical examination shows a very unstable shoulder with a positive apprehension test. The CT Scan above quite clearly shows a large bony Bankart lesion.
In patients with recurrent instability it is important to exclude a bony Bankart lesion. This is a fracture of the anterior and inferior aspect of the glenoid. This makes the shoulder highly unstable. If the fragment is large as in this case, an arthroscopic stabilisation has an extremely high rate of failure and a bone graft procedure (such as a Latarjet Procedure) is required. This operation involves performing an osteotomy of the coracoid and then transferring it down to the anterior aspect of the glenoid. It results in a high degree of stability but is obviously a significant operation. Nowadays most patients undergoing surgery for shoulder instability should have a CT Scan to exclude a significant bony Bankart lesion.