Common Fracture Eponyms

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

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

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Fracture Eponym?
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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

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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

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Fracture Eponym?
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Smiths 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

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Smiths 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."

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Fracture Eponym?
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Monteggias 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

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Monteggias 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

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Fracture Eponym?
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Galeazzis 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

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Galeazzis 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

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Fracture Eponym?
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Bennetts 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

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Bennetts 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

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Fracture Eponym?
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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

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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

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Fracture Eponym?
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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.

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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

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Fracture Eponym?
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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 (18091897)

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Fracture Eponym?
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Boxers 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 dont use a roundhouse motion when
  punching usually see fracture of index
  metacarpal in professional fighter

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References

• Canale. Campbells Operative Orthopaedics, 9th
  ed. Mosby 1998.
• Chapman. Chapmans 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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The End!
South Sister and Green Lake