Common Fracture Eponyms Christopher L. Graham, MS4, Oregon Health & Science University.

Common Fracture Common Fracture EponymsEponyms

Christopher L. Graham, MS4, Oregon Health & Science University

ObjectivesObjectives

Radiographic recognition of common Radiographic recognition of common fracture patternsfracture patterns

Overview of fracture mechanism and Overview of fracture mechanism and associated radiographic findingsassociated radiographic findings

Brief history/background information Brief history/background information on source of fracture eponymon source of fracture eponym

Fracture Eponym?Fracture Eponym?

CollesColles FractureFracture Generally results from fall Generally results from fall

on outstretched hand on outstretched hand (FOOSH mechanism)(FOOSH mechanism)

Transverse fracture of Transverse fracture of distal radius with dorsal distal radius with dorsal displacement and displacement and angulation of distal angulation of distal fragmentfragment

50-60% of cases have 50-60% of cases have associated ulnar styloid associated ulnar styloid fracturefracture

Results in “Dinner Fork” Results in “Dinner Fork” deformitydeformity

Colles Fracture - Colles Fracture - BackgroundBackground

Named after Named after Abraham Colles Abraham Colles (1773-1843), an (1773-1843), an Irish surgeon and Irish surgeon and anatomistanatomist

Fracture accurately Fracture accurately described by Colles described by Colles in the Edinburgh in the Edinburgh Medical and Medical and Surgical Journal in Surgical Journal in 18141814

Fracture Eponym?Fracture Eponym?

Smith’s FractureSmith’s Fracture Result of fall on flexed Result of fall on flexed

hand or backward fall on hand or backward fall on palm of outstretched palm of outstretched handhand

Transverse fracture of Transverse fracture of distal radius with volar distal radius with volar displacement and displacement and angulation of distal angulation of distal fragmentfragment

AKA reversed Colles AKA reversed Colles fracturefracture

Results in “Garden Results in “Garden Spade” deformitySpade” deformity

Smith’s Fracture - Smith’s Fracture - BackgroundBackground

Named after Robert Named after Robert William Smith (1807-William Smith (1807-1873), an Irish surgeon1873), an Irish surgeon

In 1847, fracture first In 1847, fracture first described by Smith in described by Smith in "A Treatise on "A Treatise on Fractures in the Fractures in the Vicinity of Joints, and Vicinity of Joints, and on Certain Forms of on Certain Forms of Accidents and Accidents and Congenital Congenital Dislocations." Dislocations."

Fracture Eponym?Fracture Eponym?

Monteggia’s FractureMonteggia’s Fracture Most commonly results Most commonly results

from fall on outstretched from fall on outstretched hand with forced hand with forced pronation, or direct pronation, or direct trauma to forearmtrauma to forearm

Fracture of proximal or Fracture of proximal or middle third of ulna with middle third of ulna with dislocation of radial head dislocation of radial head (anterior or posterior)(anterior or posterior)

Comprises 1-2% of all Comprises 1-2% of all forearm fracturesforearm fractures

Monteggia’s Fracture - Monteggia’s Fracture - BackgroundBackground

Named after Giovanni Named after Giovanni Battista Monteggia Battista Monteggia (1762-1815), a surgeon (1762-1815), a surgeon and professor in Milan, and professor in Milan, ItalyItaly

He described this He described this fracture pattern in the fracture pattern in the pre-Roentgen era based pre-Roentgen era based solely on history and solely on history and physical examination physical examination findingsfindings

Interestingly, Monteggia Interestingly, Monteggia acquired syphilis by acquired syphilis by cutting himself at autopsycutting himself at autopsy

Fracture Eponym?Fracture Eponym?

Galeazzi’s FractureGaleazzi’s Fracture Results from fall on Results from fall on

outstretched hand with outstretched hand with forearm in pronation. forearm in pronation. Rotation of body with hand Rotation of body with hand fixed to ground causes fixed to ground causes hyperpronation and hyperpronation and subsequent fracturesubsequent fracture

Fracture between middle Fracture between middle and distal 1/3 of radius and distal 1/3 of radius with associated disruption with associated disruption of distal radioulnar jointof distal radioulnar joint

Comprises 3-7% of all Comprises 3-7% of all forearm fracturesforearm fractures

Galeazzi’s Fracture - Galeazzi’s Fracture - BackgroundBackground

Ricardo Galeazzi (1866-1952), an Italian surgeon at the Ricardo Galeazzi (1866-1952), an Italian surgeon at the Instituto de Rachitici in Milan, described this fracture Instituto de Rachitici in Milan, described this fracture in 1935in 1935

Fracture synonymous with his name despite being Fracture synonymous with his name despite being originally described by Sir Astley Cooper in 1842originally described by Sir Astley Cooper in 1842

Fracture Eponym?Fracture Eponym?

Bennett’s Fracture Bennett’s Fracture DislocationDislocation

Results from axial blow Results from axial blow directed against a directed against a partially flexed partially flexed metacarpal (fist fight)metacarpal (fist fight)

Intraarticular Intraarticular fracture/dislocation of fracture/dislocation of the base of the first the base of the first metacarpalmetacarpal

Volar fragment of Volar fragment of metacarpal continues to metacarpal continues to articulate with trapeziumarticulate with trapezium

Most frequent thumb fxMost frequent thumb fx

Bennett’s Fracture - Bennett’s Fracture - BackgroundBackground

Edward Hallaran Edward Hallaran Bennett (1837-1907), Bennett (1837-1907), an Irish surgeon, an Irish surgeon, originally described originally described fracture in 1882fracture in 1882

Of interest, in college Of interest, in college Bennett studied under Bennett studied under Dr. Robert William Dr. Robert William Smith, and introduced Smith, and introduced antisepsis to Dublinantisepsis to Dublin

Fracture Eponym?Fracture Eponym?

Jones FractureJones Fracture Results from laterally directed Results from laterally directed

force on the forefoot during force on the forefoot during plantar flexion of the ankleplantar flexion of the ankle

Fracture at base of fifth Fracture at base of fifth metatarsal located 1.5 – 3.0 metatarsal located 1.5 – 3.0 cm distal to tuberosity (styloid cm distal to tuberosity (styloid process) of fifth metatarsal – process) of fifth metatarsal – patients often develop patients often develop persistent nonunionspersistent nonunions

Avulsion fractures at Avulsion fractures at tuberosity involving peroneus tuberosity involving peroneus brevis tendon are more brevis tendon are more common (termed pseudo-Jones common (termed pseudo-Jones or tennis fracture) – better or tennis fracture) – better prognosis than Jones fractureprognosis than Jones fracture

Jones Fracture - Jones Fracture - BackgroundBackground

Sir Robert Jones (1855-Sir Robert Jones (1855-1933), an English 1933), an English orthopaedic surgeon, orthopaedic surgeon, first described fracture first described fracture in 1902in 1902

Actually described his Actually described his own fracture after own fracture after injuring himself while injuring himself while dancing around a dancing around a Maypole at a military Maypole at a military garden party garden party

Fracture Eponym?Fracture Eponym?

Tillaux FractureTillaux Fracture Results from external Results from external

rotation force with stress rotation force with stress placed on anterior placed on anterior tibiofibular ligamenttibiofibular ligament

Salter Harris type III Salter Harris type III fracture involving avulsion fracture involving avulsion of anterolateral tibial of anterolateral tibial epiphysis via anterior epiphysis via anterior tibiofibular ligamenttibiofibular ligament

Middle and medial portions Middle and medial portions of physis close first. This of physis close first. This injury generally seen in injury generally seen in older adolescents before older adolescents before lateral physis has closed.lateral physis has closed.

Tillaux Fracture - Tillaux Fracture - BackgroundBackground

Sir Astley Cooper (at Sir Astley Cooper (at left) first described this left) first described this fracture in 1822 (recall fracture in 1822 (recall he also first described he also first described the Galeazzi fracture!)the Galeazzi fracture!)

In 1892, Paul Jules In 1892, Paul Jules Tillaux (1834-1904), a Tillaux (1834-1904), a French surgeon, French surgeon, delineated the delineated the mechanism of this injury mechanism of this injury as an avulsion fractureas an avulsion fracture

Fracture Eponym?Fracture Eponym?

Maisonneuve FractureMaisonneuve Fracture Results from external Results from external

rotation force applied to the rotation force applied to the ankle with the foot in either ankle with the foot in either supination or pronationsupination or pronation

Spiral fracture of proximal Spiral fracture of proximal 1/3 of fibula with associated 1/3 of fibula with associated syndesmotic ligament syndesmotic ligament disruption and injury to the disruption and injury to the medial ankle structures medial ankle structures (medial malleolus or deltoid (medial malleolus or deltoid ligament) ligament)

Originally described in 1840 Originally described in 1840 by Jacques Gilles by Jacques Gilles Maisonneuve (1809–1897)Maisonneuve (1809–1897)

Fracture Eponym?Fracture Eponym?

Boxer’s FractureBoxer’s Fracture Caused by striking a solid Caused by striking a solid

object with a closed fistobject with a closed fist

Metacarpal neck fracture Metacarpal neck fracture of little finger with volar of little finger with volar angulation of metacarpal angulation of metacarpal headhead

Skilled boxers rarely Skilled boxers rarely suffer this fracture as suffer this fracture as they don’t use a they don’t use a “roundhouse” motion “roundhouse” motion when punching – usually when punching – usually see fracture of index see fracture of index metacarpal in metacarpal in professional fighterprofessional fighter

ReferencesReferences

1.1. Canale. Campbell’s Operative Orthopaedics, Canale. Campbell’s Operative Orthopaedics, 99thth ed. Mosby 1998. ed. Mosby 1998.

2.2. Chapman. Chapman’s Orthopaedic Surgery, 3Chapman. Chapman’s Orthopaedic Surgery, 3rdrd ed. Lippencott 2001ed. Lippencott 2001

3.3. Wiesel and Delahay. Principles of Orthopaedic Wiesel and Delahay. Principles of Orthopaedic Medicine and Surgery. W.B. Saunders Medicine and Surgery. W.B. Saunders Company 2001Company 2001

4.4. www.emedicine.comwww.emedicine.com5.5. www.learningradiology.comwww.learningradiology.com6.6. www.wheelessonline.comwww.wheelessonline.com7.7. www.whonamedit.comwww.whonamedit.com8.8. www.www.worldorthoworldortho.com.com

The End!The End!

South Sister and Green Lake