Bone Doc Bankart and his Lesion

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April 15, 2013 by EmerJencyWEBB

Labrum comes from the latin word for lip (think labia).  Both the hip and the shoulder (ball and socket joints) have a labrum.  In the shoulder, the labrum deepens the “socket” formed initially by the glenoid cavity and provides structure and support to the humeral head.

Lateral view of the shoulder showing the glenoid labrum (marked “glenoid ligament”). From Gray’s Anatomy, via Wikipedia.

An anteriorly dislocated humeral head (or recurrent dislocations) can stretch the inferior glenohumeral ligament.  This can pull the inferior labrum away from the glenoid, increasing instability, and is known as a Bankart Lesion.  If the labrum tears and takes a small piece of bone with it, it is called a bony Bankart Lesion.  A shoulder with this degree of inferior glenohumeral instability is prone to recurrent anterior dislocations.

The arrows point to a bony Bankart lesion. Source: http://www.radiologyassistant.nl/en/p4963d77684ef7/shoulder-bankart.html

But who was Bankart?

The man, the myth, the legend.

Arthur Sidney Blundell Bankart (1879 – 1951) was an English orthopedic surgeon who described the lesion and popularized it’s surgical repair.  Bankart loved to operate, as illustrated in this anecdote describing his days as a surgical registrar:

“He was fond of telling how, when the surgeons went away for their summer holidays – and it seems they all went at once – he discharged all the old patients and brought in a full complement of new ones; these he operated upon without delay, working the operating theater staff as never before, and achieving a record turnover.” – Who’s Who in Orthopedics, Edited by Mostofi, 2005

 
Wow!  I don’t think a modern trainee would survive the wrath of residency leadership if this was tried today.  Bankart kept up this tenacity and love for the operating room until his death after a full day in the OR in 1951.

Bankart lesions may be treated nonoperatively by initial immobilization followed by physical therapy, but continued instability is treated by surgical repair.  The perfect pathology for an operating addict.

 

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