Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
권호 표지
DOI QR코드

DOI QR Code

Unrecognized bony Bankart lesion accompanying a dislocated four-part proximal humerus fracture before surgery: a case report

  • Lee, Seungjin (Department of Orthopedic Surgery, Kangdong Sacred Heart Hospital) ;
  • Shin, Daehun (Department of Orthopedic Surgery, Kangdong Sacred Heart Hospital) ;
  • Hyun, Yoonsuk (Department of Orthopedic Surgery, Kangdong Sacred Heart Hospital)
  • Received : 2021.10.28
  • Accepted : 2021.11.22
  • Published : 2022.03.01
Download PDF
⟨ Previous Next ⟩

Abstract

Proximal humerus fractures are the third most common fractures, totaling 4% to 5% of all fractures. Here, we present the case of a 39-year-old man with a dislocated four-part fracture of the proximal humerus with a huge bony Bankart lesion. Preoperatively, the bony Bankart lesion of the glenoid was not visualized on computed tomography scans or magnetic resonance imaging because the fracture of the proximal humerus was comminuted, displaced, and complex. It was planned for only the humerus fracture to be treated by open reduction and internal fixation using a locking plate. However, a fractured fragment remained under the scapula after reduction of the dislocated humeral head. This was mistaken for a dislocated bone fragment of the greater tuberosity and repositioning was attempted. After failure, visual confirmation showed that the bone fragment was a piece of the glenoid. After reduction and fixation of this glenoid part with suture anchors, we acquired a well-reduced fluoroscopic image. Given this case of complex proximal humerus fracture, a glenoid fracture such as a bony Bankart lesion should be considered preoperatively and intraoperatively in such cases.

Keywords

References

  1. Lahav A, Rogachefsky R, Toledano B, Meinhard BP. The management of anterior dislocation of the shoulder with proximal humerus fracture, bony Bankart lesion, and associated glenoid labrum avulsion: a report of 2 cases. Am J Orthop (Belle Mead NJ) 2003;32:349-52. https://doi.org/10.1111/j.1939-0025.1962.tb04052.x
  2. Garofalo R, Brody F, Castagna A, Ceccarelli E, Krishnan SG. Reverse shoulder arthroplasty with glenoid bone grafting for anterior glenoid rim fracture associated with glenohumeral dislocation and proximal humerus fracture. Orthop Traumatol Surg Res 2016;102:989-94. https://doi.org/10.1016/j.otsr.2016.09.009
  3. Oh JC, Kim HS, Lee GH, Kang HJ. Arthroscopic treatment of a one-fourth anteroinferior glenoid comminuted fracture-dislocation with concomitant three-part complex proximal humerus fracture in a middle-aged man: a case report. Arch Orthop Trauma Surg 2020;140:1901-7. https://doi.org/10.1007/s00402-020-03402-w
  4. Court-Brown CM, Garg A, McQueen MM. The epidemiology of proximal humeral fractures. Acta Orthop Scand 2001;72:365-71. https://doi.org/10.1080/000164701753542023
  5. Iglesias-Rodriguez S, Dominguez-Prado DM, Garcia-Reza A, et al. Epidemiology of proximal humerus fractures. J Orthop Surg Res 2021;16:402. https://doi.org/10.1186/s13018-021-02551-x
  6. Maassen NH. Treatment of a 4-part proximal humeral fracture with a concomitant glenoid fracture in an elderly patient: a case report. JBJS Case Connect 2019;9:e13. https://doi.org/10.2106/jbjs.cc.18.00237
  7. Attarde D, Patil A, Kamat N, Sancheti P, Shyam A. Anterior proximal humerus fracture dislocation with concomitant glenoid fracture: an operative challenge! A case report. Trauma 2021 May 17 [Epub]. https://doi.org/10.1177/14604086211019528.
  8. Ong JC, Awadallah MA, White AJ, Robinson PM. The 'floating humeral head', a case series of combined proximal humeral and glenoid fracture dislocations. J Orthop Orthop Surg 2020;1:19-24. https://doi.org/10.29245/2767-5130/2020/3.1122
  9. Tamai K, Ishige N, Kuroda S, et al. Four-segment classification of proximal humeral fractures revisited: a multicenter study on 509 cases. J Shoulder Elbow Surg 2009;18:845-50. https://doi.org/10.1016/j.jse.2009.01.018
  10. Solberg BD, Moon CN, Franco DP, Paiement GD. Locked plating of 3- and 4-part proximal humerus fractures in older patients: the effect of initial fracture pattern on outcome. J Orthop Trauma 2009;23:113-9. https://doi.org/10.1097/BOT.0b013e31819344bf