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Combined Posterior Osseous Bankart Lesion and Posterior Humeral Avulsion of the Glenohumeral LigamentsA Case Report and Pathoanatomic Subtyping of “Floating” Posterior Inferior Glenohumeral Ligament Lesions
James B. Ames, MD, MS1; Peter J. Millett, MD, MSc1
1 Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO 81657. E-mail address for P.J. Millett: drmillett@steadmanclinic.net
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Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

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Investigation performed at the Steadman Philippon Research Institute, Vail, Colorado

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Oct 19;93(20):e118 1-4. doi: 10.2106/JBJS.K.00010
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The pathoanatomy of anterior shoulder dislocations has been well documented. Perthes1 described an anterior labral lesion as early as 1906, and Bankart2 wrote his classic article on recurrent anterior dislocations more than seventy years ago. Until recently, much less had been written about posterior shoulder instability; to our knowledge, the first case series was reported by Reeves3 in 1963. Recurrent posterior glenohumeral joint instability is far less common than anterior instability, accounting for approximately 2% to 10% of all cases of shoulder instability4. Pathoanatomic findings in patients with unidirectional posterior instability include a posterior Bankart lesion, posterior humeral avulsion of the glenohumeral ligament (PHAGL), and various combinations of the two5,6. In their article on humeral avulsion of the glenohumeral ligament (HAGL), Bui-Mansfield et al.7 defined the floating posterior inferior glenohumeral ligament (floating PIGHL) as a combined posterior Bankart lesion and PHAGL. Multiple cases of this lesion have been reported in the literature7-11. To our knowledge, there has been no reported case of the specific combination of a posterior osseous Bankart lesion and a PHAGL injury. We present a case of recurrent posterior instability associated with a combined PHAGL injury and posterior osseous Bankart lesion. We also describe four pathoanatomic subtypes of floating PIGHL lesions. The patient was informed that data concerning his case would be submitted for publication, and he provided consent.
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