Arthroscopic Management and Radiographic Interpretation of an Everted Bony Bankart Lesion

Soft tissue injuries are prevalent after traumatic anterior shoulder dislocation. However, bony fractures, often referred to as bony Bankart injuries, are less common. The authors describe the case of a 16-year-old male who displayed a bony Bankart with a unique, everted presentation. The patient presented with left shoulder pain, restricted range of motion, and crepitus. Two weeks prior to physical examination, he sustained a traumatic anterior glenohumeral dislocation after a bicycle accident, which reduced spontaneously. Plain film imaging revealed a bony fragment off the anterior glenoid. Upon critical examination of magnetic resonance imaging axial cuts, the bony fragment was found to be flipped. Intraoperatively, this orientation was confirmed. The fragment was reduced and stabilized in an anatomic position using a double row technique with the capsule then advanced over the top of the fragment using three additional anchors. Imaging four months postoperatively revealed an anatomical reduction of the fragment. To the authors' knowledge, this is the first reported case of bony fragment eversion following traumatic anterior shoulder dislocation. Although the incidence of everted bony fragments following traumatic dislocation is unknown, such a situation presents unique challenges to the orthopedic surgeon. The authors discuss potential eversion mechanisms, fragment identification by imaging, surgical indications, and operative techniques.