Eponymous Fractures Name

Dr. Muhammad Bin ZulfiqarPGR III FCPS Services Hospital Lahore / Services

Institute of Medical Science

Eponymous Fractures Name• Bankart fracture• Barton fracture.• Bennett fracture.• Busch fracture. • Chance fracture• Chopart fracture. • Colles fracture. • Cotton fracture. • De Quervain fracture• Dupuytren fracture• Duverney fracture. • Essex-Lopresti fracture

Eponymous Fractures Name• Galeazzi fracture.• Gosselin fracture. • Holdsworth fracture. • Hutchinson fracture.• Jefferson fracture• Jones fracture.• Le Fort fracture (maxilla). • Le Fort fracture (ankle). • Lisfranc fracture. • Maisonneuve fracture. •

Eponymous Fractures Name

• Malgaigne fracture. • Mason fracture• Pott fracture. • Rolando fracture. • Segond fracture.• Shepherd fracture.• Skillern fracture. • Smith fracture. • Tillaux fracture.

Eponymous Fractures Name

• Hangman’s fracture. • Boxer’s fracture. • Clay shoveler’s fracture.• Gamekeeper’s thumb. • Greenstick fracture. • Torus fracture. • March fracture. • Dancer’s fracture.

Bankart fracture.

• One of the most frequently used eponyms, this refers to a fracture of the anteroinferior portion of the glenoid labrum associated with anterior dislocation of the humeral head, which is the mechanism causing the break. It is difficult to recognize a Bankart fracture on plain radiographs, and sometimes it can only be detected with the use of CT (Fig. A3-1) or MRI.

• ■ FIGURE A3-1 Bankart fracture is better visualized with special techniques, such as this CT arthrography in coronal (A) and axial (B) views.

Barton fracture.

• Barton fractures affect the articular surface of the radius (Fig. A3-2) and are associated with dorsal or ventral displacement of the bone fragment with respect to the carpal bones. The fracture is produced by a shearing mechanism and often requires surgery, and it is oriented in the coronal plane.

Barton fracture. The fracture line reaches the joint.

Bennett fracture.

• A Bennett fracture involves fracture-dislocation at the base of the first metacarpal. Because this is the insertion site of the abductor pollicis longus, it is virtually impossible to reduce it without surgery (Fig. A3-3).

• FIGURE A3-3 Bennett fracture.

Busch fracture.

• A Busch fracture consists of fracture with detachment of a fragment of the distal phalanx of the finger and the extensor tendon, which inserts at this site (Fig. A3-4). It is also known as “baseball finger” because it occurs frequently in baseball players.

Busch fracture-detachment with detachment of a fragment of the distal phalanx of the finger and the extensor tendon.

Chance fracture.

• This fracture is also referred to as “seat belt fracture” because it results from hyperflexion while wearing a seatbelt across the waist. Chance fractures generally affect the L1 or L2 vertebra and are characterized by a horizontal fracture line that compromises the vertebral body or the posterior elements or both. When both structures are affected, the fracture is extremely unstable and requires surgery (Fig. A3-5).

The Chance fracture requires additional assessment with MR (A and B). In this example involvement of the vertebral body and posterior elements is evident, requiring urgent surgery.

Chopart fracture.

• A Chopart fracture consists of fracture-dislocation of the midtarsal joints (i.e., the tarsonavicular and calcaneocuboid joints).

• Chopart's fracture dislocation. Black arrow points to talus which is dislocated from navicular (yellow arrow) at talonavicular joint. Calcaneus (blue arrow) is dislocated from the cuboid (red arrow), which is also fractured. The dislocation is at the calcaneocuboid joint. This is an uncommon dislocation. The forefoot is usually displaced medially rather than laterally as in this case.

Colles fracture.

• This is possibly the most “famous” eponym but also the one most poorly used. A Colles fracture affects the distal radius without compromising the joint and occurs with dorsal displacement of the distal fragment and volar angulation (dinner fork deformity). It is sometimes associated with fracture of the ulnar styloid process. The lesion is produced by a fall on an outstretched hand. In France and French-speaking countries the eponym “Pouteau” is used (Fig. A3-6).

A and B, An example of a classic Colles or Pouteau fracture.

Cotton fracture.

• Also known as trimalleolar fracture of the ankle, Cotton fracture affects both malleoli and, additionally, produces a displaced fracture from the posterior margin of the tibial articular surface. The eponym is infrequently used (Fig. A3-7).

• ■ FIGURE A3-7 A and B, Cotton fracture. In addition to the fractures of the lateral and medial malleoli there is also a fracture of the posterior tibia and subluxation.

De Quervain fracture.

• The name De Quervain is applied to fractures of the scaphoid associated with dislocation of the semilunar bone (Fig. A3-8).

De Quervain fracture.

Dupuytren fracture.

• A Dupuytren fracture affects the tibia above the lateral malleolus, with rupture of the distal tibiofibular ligaments and deltoid ligament. There may be an associated fracture of the medial malleolus and lateral displacement of the talus (Fig. A3-9).

Example of a Dupuytren fracture.

Duverney fracture.

• A Duverney fracture involves the iliac wing immediately below the anterior-superior iliac spine, with no other concomitant fractures.

Duverny Fracture

Essex-Lopresti fracture.

• The name Essex-Lopresti refers to a fracture of the radial head, usually producing several fragments and displacement. In addition, there is distal dislocation of the radioulnar joint.

Essex Lopresti Fracture

Galeazzi fracture.

• A Galeazzi fracture involves the radius, usually the radial diaphysis, with dislocation of the distal radioulnar joint (Fig. A3-10). Often the dislocation is only evident on clinical examination and cannot be recognized on radiography.

Galeazzi fracture.

Gosselin fracture.

• A fracture having a V shape, Gosselin fracture affects the distal tibia with intra-articular extension.

Gosselin fracture.

Hill-Sachs lesion

• Impacted fracture of the posterolateral aspect of the humeral head caused by impingement of the head on the anterior edge of the scapular glenoid during anterior dislocation of the shoulder.Increased risk of recurrent dislocations

Holdsworth fracture.

• Holdsworth fracture is an unstable spinal fracture at the thoracolumbar junction affecting the vertebral body, articular processes, and posterior ligaments.

Hutchinson fracture.

• An oblique fracture of the radial styloid process (Fig. A3-11), Hutchinson fracture is also known as “chauffeur fracture.” At the beginning of the past century it was often caused by the kickback produced when starting an automobile by hand-cranking.

Jefferson fracture.

• A complex fracture of the atlas, Jefferson fracture usually affects both the anterior and posterior arches as well as the lateral masses (Fig. A3-12).

Jefferson fracture. Atlas fractures should be assessed by CT.

Jones fracture.

• The Jones fracture affects the base of the fifth metatarsal distal to the tuberosity (Fig. A3-13). It should not be confused with fracture-avulsion of the base of fifth metatarsal, known as “dancer’s fracture” or “pseudo-Jones fracture,” which occurs proximal to the tuberosity and is related to the peroneus brevis tendon. Jones fracture should also be differentiated from a lack of fusion of the ossification center.

Jones fracture. Fracture of the base of the fifth metatarsal.

Le Fort fracture (maxilla).

• There are three types of Le Fort maxillary fractures. Type I is a bilateral horizontal fracture of the upper maxilla. Type II has a more vertical fracture line and can reach floor of the orbit, nasal cavity, or hard palate. In type III there is complete detachment of the maxilla and one or more facial bones from the remaining craniofacial skeleton.

• Leforte II

Le Fort fracture (ankle).

• The Le Fort ankle fracture is a vertical fracture of the fibula with avulsion of the tibiofibular ligament.

Lisfranc fracture.

• Lisfranc fracture is associated with dislocation of the tarsometatarsal joints. The most frequent type involves fracture of the base of the second metatarsal (anatomically wedged between the medial and lateral cuneiform bones) and posterolateral dislocation of four or all five metatarsals. In normal conditions the internal margin of the second cuneiform and that of the base of the second metatarsal should be aligned. This injury is more frequent in neuropathic conditions (e.g., diabetes) than after trauma (Fig. A3-14).

Lisfranc fracture. This is an example of a fracture of the second metatarsal base with dislocation from the second to the third metatarsal.

Maisonneuve fracture.

• The Maisonneuve fracture refers to a spiral fracture of the proximal third of the fibula with disruption of the distal tibiofibular syndesmosis and interosseous membrane. It can be associated with fracture of the medial malleolus or deltoid ligament rupture (Fig. A3-15).

Maisonneuve fracture. Fracture of the proximal third of the fibula and the medial malleolus.

Malgaigne fracture.

• The Malgaigne fracture involves both pubic rami with sacroiliac dislocation or fracture of the sacrum. The lateral fragment, which contains the acetabulum, is unstable (Fig. A3-16).

• ■ FIGURE A3-16 Malgaigne fracture. In this image, fracture of the hemisacrum and both right pubic rami can be observed

Mason fracture.

• Mason fracture is an isolated fracture of the radial head (Fig. A3-17).

• ■ FIGURE A3-17 Mason fracture. This fracture may manifest merely as a radial head deformity.

Monteggia fracture.

• Monteggia fracture is a proximal ulnar fracture with anterior dislocation of the radial head (Fig. A3-18).

• ■ FIGURE A3-18 Lateral view of a Monteggia fracture.

Pott fracture.

• A bimalleolar fracture, Pott fracture was originally described as a subluxation of the ankle with fracture of the distal third of the fibula and tearing of the medial ligaments of the joint (Fig. A3-19).

• ■ FIGURE A3-19 Pott fracture. Fibular fracture and subluxation of the talus due to rupture of the deltoid ligament.

Pipkin fracture

• Impact to the knee with the hip flexed (dashboard injury)Fracture of femoral head in association with posterior dislocation of hip.

Pellegrini-Stieda disease Steida fracture Pellegrini’s syndrome

• Ossification of the superior portion of the medial collateral ligament of the knee Sequela of an old injury (or injuries) to the medial collateral ligament (MCL) of the knee

• Ossification of the superior portion of the medial collateral ligament of the knee Sequela of an old injury (or injuries) to the medial collateral ligament (MCL) of the knee

Rolando fracture.

• A comminuted intra-articular fracture, Rolando fracture affects the base of the first metacarpal and is associated with dislocation (Fig. A3-20). It is similar to a Bennett fracture.

• ■ FIGURE A3-20 Rolando fracture.

Segond fracture.

• The name Segond fracture is applied to fracture-detachment of the proximal tibial epiphysis, almost always associated with rupture of the anterior cruciate ligament (Fig. A3-21).

• FIGURE A3-21 Segond fracture. This fracture is related with insertion of the tensor muscle tendon of the fascia lata.

Reverse Segond Fracture

• Cortical avulsion of tibial insertion of deep capsular component of medial collateral ligament

• Mechanism: external rotation +valgus stress• May be associated with: midsubstance tear of

posterior cruciate ligament; avulsion of PCL from posterior tibial plateau; tear of medial meniscus

• Elliptic bone fragment arising from medial aspect of proximal tibia

• Figure 2. Reverse Segond fracture. (a) Anteroposterior radiograph of the right knee shows an elliptic bone fragment (arrow) arising from the medial tibial plateau. (b) Coronal fast spin-echo proton density– weighted MR image shows the tiny bone fragment (white arrow), which represents an avulsion of the deep capsular component of the medial collateral ligament. Irregularity of the donor site from the tibial cortex is also seen (black arrow).

Shepherd fracture.

• This is a fracture of the posterolateral process of the talus (Fig. A3-22) and should not be mistaken for a normal variant, the os trigonum.

• FIGURE A3-22 Shepherd fracture. Subtle fracture of the posterior talus.

Skillern fracture.

• The Skillern fracture is a complete fracture of the lower third of the radius with a greenstick or torus fracture of the ulna (Fig. A3-23).

• ■ FIGURE A3-23 Skillern fracture. This association is not infrequent in children.

Smith fracture.

• An extra-articular fracture of the distal third of the radius with volar (palmar) displacement of the distal fragment, the Smith fracture can be considered a reverse Colles fracture (Fig. A3-24).

• ■ FIGURE A3-24 Smith fracture is the reverse of a Colles fracture.

Tillaux fracture.

• A Tillaux fracture consists of fracture-avulsion of the vertical course of the anterior tibial tubercle at the insertion of the anterior tibiofibular ligament. It is more common in older adolescents, in whom the medial portion of the distal tibial physis is already closed but the lateral area remains open. It is sometimes seen in adults (Fig. A3-25).

FIGURE A3-25 Tillaux fracture with a vertical course.

Hangman’s fracture.

• Hangman’s fracture consists of a fracture of the posterior elements of C2 and anterior displacement of the C2 vertebral body with respect to the C3 body (Fig. A3-26).

• ■ FIGURE A3-26 Hangman’s fractures are generally related to traffic accidents.

Boxer’s fracture.

• As its name indicates, boxer’s fracture results from an impact made with a closed fist (Fig. A3-27). A fracture is produced at the neck of the fifth metacarpal with volar angulation of the distal fragment.

• ■ FIGURE A3-27 Boxer’s fracture. This is one of the most common fractures and is related to the “peaceful” nature of our society.

Clay Shoveler’s Fracture.

• This term refers to a fracture of a lower cervical spinous process due to traction by the interspinous ligaments. These structures exert considerable force on the spinous processes when pulling up on a shovel and throwing the contents over the shoulder. The lesion is now more often a result of traffic accidents (Fig. A3-28).

• Fracture of spinous process of C-6 vertebrae.

Gamekeeper’s thumb.

• An injury that should now be called “skier’s thumb,” gamekeeper’s thumb consists of fracture-dislocation of the ulnar aspect of the base of the first phalanx associated with a lesion of the ulnar collateral ligament of the first metacarpophalangeal joint (Stener and non-Stener lesion).

• Avulsed bone fragment is seen.

Greenstick fracture.

• A lesion observed in children, greenstick fracture is related to the plasticity of the bone at this stage of development and to the strength of the periosteum. It predominantly affects the bones of the forearm and is characterized by the fact that one side of the bone is fractured while the opposite side remains intact (Fig. A3-29).

• FIGURE A3-29 Greenstick fracture of the cubitus.

Torus fracture.

• Another type of incomplete fracture seen in children, torus fracture usually affects the distal radial diaphysis (Fig. A3-30). Its name is derived from an architectural term given to a part of the base of a Greek column.

Torus fracture is often diagnosed during resolution of the break, with visualization of sclerosis.

March fracture.

• The march fracture, which frequently occurs in military recruits, consists of a diaphyseal fatigue fracture, usually of the second or third metatarsal, due to overload during repeated impact of the forefoot on the ground while walking. The radiologic features may not be evident initially. After 1 week a radiolucent line can be seen and, later, periosteal reaction (Fig. A3-31). These fatigue fractures can also occur in other bones, such as the pelvis, femoral neck, tibia, fibula, or calcaneus, although they are much less common at these sites.

• ■ FIGURE A3-31 March fracture. Stress fracture of the third metatarsal.

Dancer’s fracture.

• Fracture-avulsion of the base of fifth metatarsal, known as “dancer’s fracture,” occurs proximal to the tuberosity and is related to the peroneus brevis tendon, also known as pseudo Jones fracture (Fig. A3-32).

• ■ FIGURE A3-32 Dancer’s fracture (pseudo Jones fracture). Fracture-avulsion of the base of fifth metatarsal.

Lovers Fracture• Calcaneus is the most commonly fractured tarsal bone• A so-called “lover’s Fracture” is an intra-articular fracture

produced by an axial loading force typically produced by a leap from a height with person landing on heels (also called a “Don Juan” fracture)– Why is it called a “Lover’s fracture?”

• Because it is the type of fracture that could presumably be caused by a lover jumping out of the bedroom window to escape from a surprised and enraged spouse

• Bilateral in up to 10%• The same axial load is transmitted to the spine and may produce

associated burst fractures of the lumbar or thoracic spine in up to 10% of patients– Frequently occur at the thoraco-lumbar junction at L1, L2, T12 and T11

• Bilateral calcaneal fractures and fractures of spine. There is a comminuted fracture of the left calcaneus (white arrow); there is a comminuted fracture of the left calcaneus (red arrow) with flattening of Bohler's Angle to 0 degrees. A sagittal reconstructed CT scan of the spine shows compression fractures of the superior endplates of T12 and L1 (yellow arrows) .

Salter Harris Fracture• The Salter-Harris classification describes fractures that involve

the epiphyseal plate or growth plate. The most common is type II, which accounts for 75%.

• Type I - transverse fracture through the growth plate or physis • Type II - fracture through the growth plate and the

metaphysis, sparing the epiphysis • Type III - fracture through growth plate and epiphysis, sparing

the metaphysis • Type IV - fracture through all three elements of the bone, the

growth plate, metaphysis, and epiphysis • Type V - compression fracture of the growth plate

• Type I• Type I Salter-Harris fractures tend to occur in younger children (5).

It is a transverse fracture through the cartilage of the growth plate or physis. • Often, x-rays of a child with a type I growth plate fracture will appear normal.• Most type I growth plate injuries are treated with a cast.

Healing of type I fractures tends to be rapid and complications are rare.

• Type II• A type II growth plate fracture starts across the growth plate, but

the fracture then continues up through the metaphysis. This is the most common type of growth plate fracture, and tends to occur in older children. Often type II growth plate fractures must be repositioned under anesthesia, but healing is usually quick and complications are uncommon.

• Type III• Type III is a fracture through the growth plate and

epiphysis sparing the metaphysis.• A type III fracture also starts through the growth plate• The fracture through the growth plate is only seen on

CT. Continue with the CT images.

• The CT-images nicely display the fracture through the growth plate and the epiphysis.

• Type IV• Type IV is a fracture through all three elements of the

bone, the growth plate, metaphysis and epiphysis. Notice that the epiphyseal fracture is in the sagittal plane, the fracture through the growth plate is in the axial plane and the metaphyseal fracture is in the coronal plane. These fractures are also named triplane fractures.These are discussed in the next chapter.

Weber Classification Danis-Weber Classification

• The Weber ankle fracture classification (sometimes Danis-Weber) is a simple system for classification of lateral malleolar fractures, relating to the level of the fracture in relation to the ankle joint.

• Type A: below level of the ankle joint with tibiofibular syndesmosis intact; deltoid ligament intact and medial malleolus often fractured

• Type B: at the level of the ankle joint, extending superiorly and laterally up the fibula. Tibiofibular syndesmosis intact or partially torn, but no widening of the distal tibiofibular articulation. Medial malleolus may be fractured or deltoid ligament my be torn.

• Type C: above the level of the ankle joint. Tibiofibular syndesmosis disrupted with widening of the distal tibiofibular articulation. Medial malleolus fracture or deltoid ligament injury present