Eponymous Fractures

Eponymous fractures, fracture-dislocations and classifications systems are often named after the physician who first described them, or popularised the naming convention or operative repair.


Bankart Lesion (1923)

Bankart lesion Fracture of the antero-inferior glenoid rim with detachment of the glenoid labrum. Associated with anterior shoulder dislocations.


Bosworth fracture (1947)
Bosworth-Fracture-2

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


Cedell fracture (1974)
Cedell-fracture-Watanabe-150

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.


Chopart amputation (1792)
Chopart fracture dislocation

The mid-tarsal joint is also known as the Chopart joint. Chopart disarticulated this joint when performing forefoot amputations (Chopart amputation). A Chopart fracture-dislocation involves a midtarsal joint (talonavicular and calcaneocuboid) dislocation with associated fractures.

Chopart’s student, Lafiteau provided the first description of Chopart’s method of partial amputation of the foot and Chopart’s joint in Volume IV of Fourcroy ‘La médecine éclairée par les sciences physiques‘ in 1792. The fracture-dislocation was attributed at a later date.

Chopart amputation Garrè, 1922

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 ]


Danis-Weber classification (1949, 1972)
Danis Weber A B C ankle fracture 150 2

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.


Freiberg infraction (1914)
Freiberg infraction 150

Osteochondrosis of the metatarsal heads (typically the 2nd metatarsal head) characterized pathologically by subchondral bone collapse, osteonecrosis, and cartilaginous fissures. Freiberg infraction is more common in women and most commonly manifests during adolescence (aged 10-18 years). Bilateral presentation in 10% of cases. Cause unknown and probably multi-factorial. High-heeled shoes have been implicated as a causative factor.

In 1913, Freiberg presented a paper to the Southern Surgical and Gynecological Association. He reported the cases of six young women presenting with a painful limp and discomfort localized to the second metatarsal, the first patient presenting in 1903. Freiberg employed used the term ‘infraction’ as the diagnosis (archaic term for fracture without displacement implying trauma as the cause).

Köhler called out Freiberg for an ‘incomplete‘ description of ‘metatarsal infraction‘ lacking mention of the widening of the joint line; thickening of the shaft of the metatarsal and obliteration of the neck. Process often referred to as Köhler disease II


Gosselin fracture (1855)
Gosselin fracture

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


Hawkins classification (1970)
Hawkins classification talus 150

Classification system for talar neck fractures. Hawkins originally described Types I-III in 1970 with Canale and Kelly adding Type IV in 1978


Jones Fracture (1902)
Jones-Fracture-5th-Metatarsal 360

Fracture of the proximal diaphysis of the 5th metatarsal, distal to the tuberosity, without joint involvement. Caused by foot inversion / twisting and repetitive stress. First described by Robert Jones on himself after he injured his foot dancing. In 1902 he wrote up a case report of five similar injuries specifically noting that the fracture is caused by ‘indirect violence

Whilst dancing, I trod on the outer side of my foot, my heel at the moment being off the ground. Something gave way midway down my foot, and I at once suspected a rupture of the peroneus longus tendonI hobbled down-stairs to my colleague…to X-ray my foot. This was done, and the fifth metatarsal was found fractured about three-fourths of an inch from its base.

Jones R, Ann Surg. 1902: 697
Jones fracture and current classification
Jones Fracture 5th metatarsal fracture
Jones fracture
Jones-fracture-Lawrence-and-Botte-5th-MT-Zones-620x310
Lawrence and Botte Classification 1993

Köhler disease I (1908)
Köhler disease 150

Köhler disease is a rare, self-limiting, avascular necrosis (osteonecrosis) of the navicular bone in children. Adult onset osteonecrosis of the tarsal navicular is known as Müller-Weiss syndrome (MWS) (also Brailsford disease)


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)


Lisfranc joint (1815)
Lisfranc joint injury

Lisfranc is eponymously associated with his tarsometatarsal forefoot amputation (Lisfranc amputation). However, Lisfranc was not the first to describe the procedure, with William Hey (1736-1819) first performing and recording the procedure in 1803.

In 1815, Lisfranc described and refined the disarticulation of the forefoot at the tarsometatarsal joint complex which joins the forefoot and midfoot (Lisfranc joint). He defined the coup de maître of his disarticulation being the incision of the interosseous ligament (subsequently referred to as the Lisfranc ligament)

Lisfranc’s description of amputation through the tarsal-metatarsal joints requires several pages to describe it, but it took only 1 minute for him to perform it — not too short a time for the unanesthetized patient

Cassebaum WH, 1963

Note: the Lisfranc ligament complex includes the dorsal, interosseous, and plantar ligaments which connect C1 (medial cuneiform) to M2 (2nd metatarsal base).

Lisfranc injury refers to disruption of the tarsometatarsal joint. Injuries range from sprain (minor diastasis) through to tarsometatarsal fracture-dislocation.

Lisfranc amputation Garrè, 1922

Maisonneuve Fracture (1840)
Maisonneuve-Fracture 150

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


Pellegrini-Stieda syndrome (1905/1908)

Köhler-Pellegrini-Stieda lesion: Ossification in or near the tibial collateral ligament (medial femoral collateral ligament) adjacent to the margin of the medial femoral condyle. Ossified post-traumatic lesion (presumed secondary to Stieda fracture)


Pott fracture (1768)
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.


Segond fracture (1879)
Segond-fracture-lateral-tibial-avulsion-150

Segond fracture: Avulsion fracture (small) of the lateral surface of the lateral tibial condyle. Usually results from excessive internal rotation and varus stress resulting in increased tension on the lateral capsular ligament of the knee joint. In the majority of cases a Segond avulsion fracture is associated with detachment of the capsular portion of the lateral collateral ligament and tears of the anterior cruciate ligament. Additional injury to menisci and other supporting ligaments may occur

In 1879 Paul Segond described this fracture during cadaveric experiments as a cortical avulsion of the tibia at the site of insertion of the middle third of the lateral capsular ligament in 17 out of 38 knees. In 1936 Henry Milch first reported the avulsion fracture on radiographs of 3 acutely injured knees

It’s never Gerdy’s tubercle that gives way, but the portion of bone immediately behind it…the lesion is pathognomonic of torsion of the knee in internal rotation and slight flexion of the lower leg and is associated with rupture of the anterior cruciate ligament

Segond 1879

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.


Tillaux-Chaput fracture (1876, 1907)
Tillaux Fracture

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)


Wagstaffe-Le Fort Fracture (1875, 1886)
Wagstaffe-Le-Fort-Fracture 150

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]


References


eponymictionary CTA

eponymythology

myths behind the history