Common Fracture Eponyms

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

2. Objectives • Radiographic recognition of common fracture patterns • Overview of fracture mechanism and associated radiographic findings • Brief history/background information on source of fracture eponym

3. Fracture Eponym?

4. CollesFracture • Generally results from fall on outstretched hand (FOOSH mechanism) • Transverse fracture of distal radius with dorsal displacement and angulation of distal fragment • 50-60% of cases have associated ulnar styloid fracture • Results in “Dinner Fork” deformity

5. Colles Fracture - Background • Named after Abraham Colles (1773-1843), an Irish surgeon and anatomist • Fracture accurately described by Colles in the Edinburgh Medical and Surgical Journal in 1814

6. Fracture Eponym?

7. Smith’s Fracture • Result of fall on flexed hand or backward fall on palm of outstretched hand • Transverse fracture of distal radius with volar displacement and angulation of distal fragment • AKA reversed Colles fracture • Results in “Garden Spade” deformity

8. Smith’s Fracture - Background • Named after Robert William Smith (1807-1873), an Irish surgeon • In 1847, fracture first described by Smith in "A Treatise on Fractures in the Vicinity of Joints, and on Certain Forms of Accidents and Congenital Dislocations."

9. Fracture Eponym?

10. Monteggia’s Fracture • Most commonly results from fall on outstretched hand with forced pronation, or direct trauma to forearm • Fracture of proximal or middle third of ulna with dislocation of radial head (anterior or posterior) • Comprises 1-2% of all forearm fractures

11. Monteggia’s Fracture - Background • Named after Giovanni Battista Monteggia (1762-1815), a surgeon and professor in Milan, Italy • He described this fracture pattern in the pre-Roentgen era based solely on history and physical examination findings • Interestingly, Monteggia acquired syphilis by cutting himself at autopsy

12. Fracture Eponym?

13. Galeazzi’s Fracture • Results from fall on outstretched hand with forearm in pronation. Rotation of body with hand fixed to ground causes hyperpronation and subsequent fracture • Fracture between middle and distal 1/3 of radius with associated disruption of distal radioulnar joint • Comprises 3-7% of all forearm fractures

14. Galeazzi’s Fracture - Background • Ricardo Galeazzi (1866-1952), an Italian surgeon at the Instituto de Rachitici in Milan, described this fracture in 1935 • Fracture synonymous with his name despite being originally described by Sir Astley Cooper in 1842

15. Fracture Eponym?

16. Bennett’s Fracture Dislocation • Results from axial blow directed against a partially flexed metacarpal (fist fight) • Intraarticular fracture/dislocation of the base of the first metacarpal • Volar fragment of metacarpal continues to articulate with trapezium • Most frequent thumb fx

17. Bennett’s Fracture - Background • Edward Hallaran Bennett (1837-1907), an Irish surgeon, originally described fracture in 1882 • Of interest, in college Bennett studied under Dr. Robert William Smith, and introduced antisepsis to Dublin

18. Fracture Eponym?

19. Jones Fracture • Results from laterally directed force on the forefoot during plantar flexion of the ankle • Fracture at base of fifth metatarsal located 1.5 – 3.0 cm distal to tuberosity (styloid process) of fifth metatarsal – patients often develop persistent nonunions • Avulsion fractures at tuberosity involving peroneus brevis tendon are more common (termed pseudo-Jones or tennis fracture) – better prognosis than Jones fracture

20. Jones Fracture - Background • Sir Robert Jones (1855-1933), an English orthopaedic surgeon, first described fracture in 1902 • Actually described his own fracture after injuring himself while dancing around a Maypole at a military garden party

21. Fracture Eponym?

22. Tillaux Fracture • Results from external rotation force with stress placed on anterior tibiofibular ligament • Salter Harris type III fracture involving avulsion of anterolateral tibial epiphysis via anterior tibiofibular ligament • Middle and medial portions of physis close first. This injury generally seen in older adolescents before lateral physis has closed.

23. Tillaux Fracture - Background • Sir Astley Cooper (at left) first described this fracture in 1822 (recall he also first described the Galeazzi fracture!) • In 1892, Paul Jules Tillaux (1834-1904), a French surgeon, delineated the mechanism of this injury as an avulsion fracture

24. Fracture Eponym?

25. Maisonneuve Fracture • Results from external rotation force applied to the ankle with the foot in either supination or pronation • Spiral fracture of proximal 1/3 of fibula with associated syndesmotic ligament disruption and injury to the medial ankle structures (medial malleolus or deltoid ligament) • Originally described in 1840 by Jacques Gilles Maisonneuve (1809–1897)

26. Fracture Eponym?

27. Boxer’s Fracture • Caused by striking a solid object with a closed fist • Metacarpal neck fracture of little finger with volar angulation of metacarpal head • Skilled boxers rarely suffer this fracture as they don’t use a “roundhouse” motion when punching – usually see fracture of index metacarpal in professional fighter

28. References • Canale. Campbell’s Operative Orthopaedics, 9th ed. Mosby 1998. • Chapman. Chapman’s Orthopaedic Surgery, 3rd ed. Lippencott 2001 • Wiesel and Delahay. Principles of Orthopaedic Medicine and Surgery. W.B. Saunders Company 2001 • www.emedicine.com • www.learningradiology.com • www.wheelessonline.com • www.whonamedit.com • www.worldortho.com

29. The End! South Sister and Green Lake