Eponymous Fractures

Eponymous Fractures

For detailed descriptions see individual fracture sections/Wheeless

ARM

COLLE’S

Fracture of the distal radius with dorsal and radial angulation and posterior displacement.

Associated: Triangular Fibro-cartilage Complex tears in 50%

SMITH’S

Fracture of the distal radius with anterior/volar/palmar displacement of the distal fragment

Closed reduction may be successful

BARTON’S

A Barton's fracture is an intra-articular fracture of the distal radius with dislocation/displacement of the radiocarpal joint.

Rim of distal radius is displaced dorsally or volarly with the hand and carpus.

It differs from Colles' or Smith's Fracture in that the dislocation is the most striking radiographic finding.

2 types: Dorsal and Palmar, (palmar more common). Barton's fracture is caused by a fall on an extended and pronated wrist increasing carpal compression force on the dorsal rim. Carpal displacement distinguishes this fracture from a Smith's or a Colles' fracture.

Reduction is the same as a Colle’s

CHAFFEUR

Fracture of radial styloid

rx of styloid are frequently accompanied by dislocations: lunate, perilunate, scaphoid.

May be seen with Dorsal Barton’s

BENNET’S

Intra-articular fracture of the base of the first metacarpal

Usually requires open reduction and internal screw fixation

ROLANDO

Comminuted fracture of the base of the 1st metacarpal

MONTEGGIA

Fracture of the prox 1/3 ulna and (anterior) dislocation of the radial head. Usually requires ORIF (ulna)

GALEAZZI

Fracture of the radial shaft with dislocation of the inferior radio-ulnar joint. Usually requires ORIF (radius)

TORUS (not a name, but may as well include it)

Torus is derived from Latin (tori) meaning a swelling or protuberance. Failure of cortex on compression side, 2-3 cm proximal to epiphysis. Torus (buckle) frxs of distal metaphysis of radius & ulna is most common frx in lower forearm in young children

Impact of indirect violence of fall on outstretched hand crumples dorsal cortex, but the volar cortex remains intact.

Distal fragment is angulated dorsally;

Deformity should not occur in torous frx because the periosteum and cortex are intact on the side of the bone opposite to fracture.

XRAY

It is important that x-ray be carefully examined to ascertain that tension side is intact; If frx is not on compression side then pt has greenstick frx, not a torus frx, & frx may proceed to deform in the cast

LEG

MAISONNEUVE:

The Maisonneuve fracture is a spiral fracture of the upper third of the fibula associated with a tear of the distal tibiofibular syndesmosis and the interosseous membrane. There is an associated fracture of the medial malleolus or rupture of the deep deltoid ligament. This type of injury can be difficult to detect. The Maisonneuve fracture is similar to the Galeazzi and Monteggia fractures.

FOOT/ANKLE

POTTS – see “ANKLE FRACTURES”

WEBER – see “ANKLE FRACTURES”

TILLAUX

Avulsion of medial aspect of lower tibia by anterior tibio-fibular ligament

JONES

Fracture of 5th Metatarsal – see “METATARSAL FRACTURES” and “JONES FRACTURE” picture

LIS FRANC

Fracture dislocation of prox metatarsals, high-energy rotational force (MVA, foot in stirrup, fall while restrained eg windsurfer)

Can’t walk on tip-toes.

MISSED IN 20%

Mx: Undisplaced – NWB/BKPOP, Displaced > 2mm – URGENT ORIF (risk of compartment syndrome)

C-SPINE

JEFFERSON

Classically described as a 4 part burst frx of the atlas, with combined anterior and posterior arch fractures;

Frx variants: include two and three part fractures;

Pediatric frx: frx proceeds thru open synchondroses, and may occur w/ minimal trauma; posterior synchondroses fuses at age 4; anterior synchondroses fuses at age 7;

Mechanism:

Axial compression; may also be caused by hyperextension, causing a posterior arch fracture;

Associated injuries: approx 1/3 of these fractures are associated with a axis fracture; approx 50% chance that some other C-spine injury is present; low rate of neurologic deficits is due to large breadth of C1 canal;

In cases of vertebral artery injury, neurologic injury can occur, may manifiest as Wallenberg's syndrome w/ ipsilateral loss of cranial nerves, Horner's syndrome, ataxia, and loss of contra-lateral pain and temp. sensation.

CHANCE

“Flexion distraction” injury (may occur thru bone or ligaments/soft tissue), and they may involve one or several levels

Flexion distraction injuries occur secondary to distractive disruption of posterior & middle columns w/ compression failure of anterior column.

CHANCE fracture commonly seen at L1

Associated with pancreatic/duodenal injury