Eponymous ankle and talus injuries

Eponymythology: The myths behind the history

Eponymythology associated with signs, symptoms, investigation and management of ankle and talus injuries, fractures and conditions. We review related eponyms, the person behind their origin, their relevance today, and modern terminology

Ankle and Talus Fracture Classification

Danis-Weber classification (1949, 1972)

The Danis-Weber classification (more commonly – the Weber classification) is a simple method of describing ankle fractures.

It has three categories (Type A, B and C.) based primarily upon the fracture of the fibula. The higher (more proximal) the fibular fracture, the greater the likelihood for ankle mortise insufficiency. first described by Robert Danis in 1949 and later modified and popularised by Bernhard Georg Weber in 1972, 10 years after Danis’ death.

• Robert Danis (1880 – 1962) Belgian general surgeon.
• Danis R. Les fractures malleolaires. In: Theorie et pratique de l’osteosynthese. Masson et Cie, Paris, 1949: 133-165
• Bernhard Georg Weber (1927 – 2002) Swiss surgeon.
• Weber BG. Aktuelle Probleme in der Chirurgie. Band 3. Die Verletzungen des oberen Sprunggelenkes [The injuries of the upper ankle] 2e, 1972

Lauge-Hansen classification of ankle injury (1950)

The Lauge-Hansen classification of ankle injuries was developed on the basis of predictable fracture patterns defined by injury mechanism and resultant radiological findings in 1950.

The Lauge-Hansen classification requires three radiographic views of the ankle (anteroposterior, mortise and lateral) and is characterised with specific two-word descriptors of the injury mechanism: The First word: describes the position of the foot at the time of injury (supination or pronation) and the Second word: describes the deforming force direction (abduction, adduction, or external rotation)

• Niels Lauge-Hansen (1899 – 1976) Danish Radiologist.
• Lauge-Hansen N. Fractures of the ankle. II. Combined experimental-surgical and experimental-roentgenologic investigations. Arch Surg. 1950; 60(5): 957-85.

Hawkins classification (1970)

Hawkins classification: Classification system for talar neck fractures. Classification system for vertical neck fractures of the talus, the commonest type of talus fracture. High energy injury usually associated with forced dorsiflexion and axial load. Associated with risk of avascular necrosis (AVN)

Hawkins originally described Types I-III in 1970 with Canale and Kelly adding Type IV in 1978

• Leland Greene Hawkins (1933 – 1991) American orthopedic surgeon
• Hawkins LG. Fractures of the neck of the talus. J Bone Joint Surg Am. 1970; 52(5): 991-1002

Eponymous Ankle Fractures

Bosworth fracture (1947)

Bosworth fracture-dislocation is an archaic eponym for rare ankle injury in which the proximal fibular fragment is entrapped (fixed displacement) behind the tibia, frequently irreducible by closed methods. Archaic term for ankle fracture-dislocation

• David Marsh Bosworth (1897 – 1979) American orthopedic surgeon.
• Bosworth DM. Fracture-dislocation of the ankle with fixed displacement of the fibula behind the tibia. J Bone Joint Surg Am. 1947; 29(1): 130-5.

Cotton fracture (1915)

Cotton fracture is a fracture of the ankle involving the lateral malleolus, medial malleolus and distal posterior aspect of the tibia (posterior malleolus). [aka *trimalleolar fracture ]

Cotton (1910) in his textbook chapter on ‘Injuries at and about the ankle‘, outlines the mechanism and reduction of Pott fracture with posterior luxation and fracture. In 1915 he described 53 cases of bimalleolar fracture with posterior luxation and fracture of the distal posterior tibia; mechanism of causation; reduction and operative treatment

• Frederic Jay Cotton (1869 – 1939) was an American orthopedic surgeon.
• Cotton FJ. A new type of ankle fracture. JAMA. 1915; 64: 318–321.

Gosselin fracture (1855)

Gosselin fracture is a V-shaped fracture of the distal tibia with extension into the tibial plafond, dividing it into anterior and posterior segments

• Léon Athanase Gosselin (1815 – 1887) was a French Surgeon.
• Gosselin LA. Les fractures en V du tibia. Bulletins et mémoires de la Société de chirurgie de Paris. 1855 p262

Maisonneuve Fracture (1840)

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. Rupture of the stabilizing ligaments of the distal tibiofibular syndesmosis will result in widening of the ankle mortise on radiographs. Additional findings such as avulsion fracture of the medial or posterior malleoli, or tear of the deltoid ligaments may also be present

• Jacques Gilles Maisonneuve (1809 – 1897) French Surgeon.
• Maisonneuve JG. Recherches sur la fracture du péroné. Archives générales de médecine 1840; 7 :165-187 and 433-473

Pott fracture (1768)

Pott fracture is an archaic eponym for fracture of the distal fibula, 2–3 inches proximal to the ankle joint.

Effectively a fracture-dislocation of the ankle, involving a fracture of the fibula, disruption of the deltoid ligaments with an intact tibiofibular ligament resulting in lateral displacement of the talus.

• Sir Percivall Pott (1714 – 1788) English surgeon.
• Pott P. Some few general remarks on fractures and dislocations. 1768: 217-260

Tillaux-Chaput fracture (1872, 1907)

The Tillaux fracture is a fracture of the anterolateral tibial epiphysis commonly seen in adolescents (Salter-Harris III tibial fracture).

Tillaux first described from experiments on cadavers in 1876. Chaput was the first to demonstrate a roentgenogram of a fracture in 1907 (*Tillaux-Chaput fracture)

• Paul Jules Tillaux (1834 – 1904) French Surgeon.
• Tillaux PJ. Recherches cliniques et expérimentales sur les fractures malléolaires. [Reported by Leon Gosselin]. Bulletin de l’Academie de médecine. 1872; 21: 817-826
• Victor Alexandre Henri Chaput (1857 – 1919) French Surgeon.
• Chaput H. Les fractures malléolaires du cou-de-pied et les accidents du travail. [Malleolar instep fractures and occupational injuries] Paris, Masson. 1907

Wagstaffe-Le Fort Fracture (1875, 1886)

Wagstaffe-Le Fort Fracture is a vertical avulsion fracture of the anteromedial aspect of the distal fibula due to avulsion of the anterior tibiofibular ligament attachment (ATFL). [aka Le Fort Ankle Fracture]

• William Warwick Wagstaffe (Sr) (1843-1910) English General surgeon
• Wagstaffe W. An unusual form of fracture of the fibula. St Thomas Hosp Rep. 1875; 6: 43-49
• Léon Clément Le Fort (1829–1893) French surgeon
• Le Fort LC. Note sur une variété non decrite de fracture verticale de la malleole externe par arrachement. [Note on an undescribed variety of vertical fracture of the lateral malleolus by avulsion.] Bull Gen Ther. 1886; 110:193-199

Talus

Cedell fracture (1974)

Cedell fracture is a posterior talar process fracture with injury to the posteromedial tubercle caused by forced dorsiflexion and pronation.

Fracture of the posterior process of the talus is an uncommon injury that is often missed on plain X-Ray and misdiagnosed as ankle sprain. In one case series, 17 of 20 patients with fractures were misdiagnosed as an ankle sprain.

• Carl-Axel Cedell (1932 – ) Swedish orthopaedic surgeon
• Cedell CA. Rupture of the posterior talotibial ligament with the avulsion of a bone fragment from the talus. Acta Orthop Scand. 1974; 45(3): 454-461

Shepherd fracture (1882)

Sherpherd fracture is a posterior talar process fracture with injury to the lateral tubercle caused by inversion or extreme equinus. Otherwise known as fracture of the lateral tubercle of the posterior process of the talus.

• Francis John Shepherd (1851 – 1929) British/Canadian general surgeon and anatomist.
• Shepherd FJ. A Hitherto Undescribed Fracture of the Astragalus (talus). J Anat Physiol. 1882; 17(1): 79–81

Clinical Examination

Simmonds-Thompson Test (1957, 1962)

Simmonds-Thompson test is a diagnostic tool for Achilles tendon rupture. The absence of foot plantarflexion on calf compression is interpreted as a positive test result and indicative of Achilles tendon rupture

Simmonds-Thompson test result should be considered positive when the physical response to calf squeezing is aberrant and the foot fails to plantarflex owing to incongruity of the Achilles tendon, indicative of rupture

• Franklin Adin ‘Sam ‘ Simmonds (1910 – 1983) English orthopaedic surgeon
• Simmonds FA. The diagnosis of the ruptured Achilles tendon. The Practitioner. 1957; 179(1069): 56-58.
• Theodore Campbell Thompson (1902 – 1986) American orthopedic surgeon.
• Thompson TC. A test for rupture of the tendo achillis. Acta Orthop Scand. 1962; 32: 461-465

References

• Hunter TB, Peltier LF, Lund PJ. Radiologic history exhibit. Musculoskeletal eponyms: who are those guys? Radiographics. 2000 May-Jun;20(3):819-36.
• Lee P, Hunter TB, Taljanovic M. Musculoskeletal colloquialisms: how did we come up with these names? Radiographics. 2004 Jul-Aug;24(4):1009-27.
• Somford MP, Wiegerinck JI, Hoornenborg D, van den Bekerom MPJ. Ankle fracture eponyms. JBJS 2013; 95(24): e198

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