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

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

Fracture Eponym?

Colles Fracture 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

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

Fracture Eponym?

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

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."

Fracture Eponym?

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

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

Fracture Eponym?

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

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

Fracture Eponym?

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

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

Fracture Eponym?

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

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

Fracture Eponym?

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.

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

Fracture Eponym?

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)

Fracture Eponym?

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

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

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