AO Standard Technique I – Screw Fixation of Anterior Glenoid Fractures (Bankart Lesions)

1. Surgical Principles / Overview

Core treatment objective

The primary goal of this procedure is anatomic restoration of the articular surface.

Screw selection

Conventional screws used for this procedure include:  

- Standard 3.5 mm lag screws  

- Cannulated 3.5 mm lag screws  

- 3.0 mm headless screws  

If fixation must pass through the joint capsule or labral tissue, headless screws are preferred.

When using headless screws, bicortical purchase is recommended; however, if only fracture compression is desired, bicortical fixation is not mandatory.

2. Preoperative Patient Preparation

The procedure may be performed in either the beach‑chair or supine position.

3. Surgical Approach

The anterior fracture fragment is reduced and fixed via the deltopectoral interval approach. For detailed description, refer to the **Deltopectoral Approach for Anterior Glenoid Fractures (AO Standard Guidelines)**.

4. Reduction Technique

K‑wires may be inserted as joysticks to assist reduction of the articular surface.

For this reason, cannulated screw systems are preferred clinically, as the inserted K‑wire can later serve as the guidewire for the lag screw.

Regardless of whether the K‑wire is subsequently used as a guidewire, when used as a reduction joystick, it must **not** be passed through the joint cavity.

If solid (non‑cannulated) screws are used, care must be taken that the K‑wire does not occupy the intended screw trajectory.

Once satisfactory reduction is achieved, advance the K‑wire further to provide provisional fixation.

When placing K‑wires, avoid the suprascapular notch region to prevent injury to the neurovascular bundle in that area.

A single lag screw cannot resist rotational displacement of the fragment; therefore, two lag screws are routinely inserted, depending on fragment size.

After definitive fixation, remove the provisional K‑wires.

Using standard fluoroscopic views (glenoid tangential view and scapular tangential view) with an image intensifier, verify screw position and fracture reduction quality. If available, a 3D CT scan may be obtained for precise confirmation of implant placement.

5. Postoperative Rehabilitation

Postoperative rehabilitation is divided into four phases:

- Inflammatory phase (weeks 1–3 postoperatively)  

- Early repair phase (weeks 4–6 postoperatively)  

- Late repair + early remodeling phase (weeks 7–12 postoperatively)  

- Remodeling and functional restoration phase (from week 13 onward)

Detailed rehabilitation protocols for each phase can be found in the corresponding references.

Source: AO Surgery Reference