Eponyms in Orthopedics

·         Mallet Finger: Extension tendon injury

·         Jersey Finger: Flexor Tendon injury

·         Coach’s finger: dorsal dislocation of PIP

·         The Essex-Lopresti fracture consists of a comminuted and displaced radial head fracture along with disruption of the distal radioulnar joint and interosseous membrane. The thickened ridge of the scaphoid and lunate facets dissipates the energy delivered to the wrist in a FOOSH injury and is thought to account for fractures that occur between the scaphoid and lunate facets of the radius. The fracture line originates at the junction of the scaphoid and lunate fossae on the radial articular surface and courses laterally in a transverse or oblique direction. The intra-articular distal radial fracture of the radial styloid is associated with an avulsion of the radial collateral ligament.

Routine PA and true lateral views are obtained. On the PA view, overlap, widening, or incongruity of the radioulnar joint should be noted. Resnick notes that careful radiographic positioning and measurements are essential, as is transaxial CT scanning or MRI, to assess the extent of displacement or subluxation of the radioulnar joint.

Complications are similar to those of a Colles fractures and include radioulnar joint instability and TFC damage.

·         Hutchinson, chauffeur's, or radial styloid fracture

The chauffeur's fracture derives its name from injuries that were acquired, in the days when motor vehicles were cranked, when a vehicle backfired. The force is described as a direct axial compression of the scaphoid into the radial facet. The radial styloid is fractured, with associated avulsion of the radial collateral ligament.A chauffeur's fracture represents an avulsion related to the attachment sites of the radiocarpal ligaments or of the radial collateral ligament. Scapholunate dissociation and lesser arc injuries of the wrist may be indicated by a fracture line on the radial articular surface between the scaphoid and lunate fossae.

·         BaRton’s fracture: fracture and dislocation of the Radio carpal joint.

·         Bennett's fracture dislocation: it is an oblique , intra-articular fracture of the base of the first metacarpal with subluxation of the trapezio-metacarpal joint .

·         Rolando's fracture:  involves 3 part frx at base of 1st metacarpal;

- inaddition to volar lip frx (as seen w/ Bennett's frx), there is also large dorsal frag,resulting in Y or T shaped intra-articular frx;

 frx is a comminuted intra-articular frx at base of thumb metacarpal, even if Y or T is not present;

 frx is uncommon but has a worse prognosis than a Bennet's frx;

·         Jefferson's fracture: Burst fracture of the ring of C1

Typically caused by an axial-loading force on the occiput of the head

Classically, it involves fractures of the anterior arch of C1 on both the right and left sides and the posterior arch of C1 on both the right and left sides (4 fractures)

·         Pilon fracture: A pilon fracture designates a fracture of the distal tibial metaphysis combined with disruption of the talar dome. This fracture originates from an axial loading mechanism in which the talus drives into the tibial plafond, such as when a patient involved in an auto accident compresses his foot on the floorboard to brace against injury. Skiers coming to an unexpected sudden stop and victims of free fall from heights also may sustain pilon fractures. Incidence of pilon fractures ranges from 1-10% of all tibial fractures.

·         Maisonneuve fracture: A Maisonneuve fracture is defined as a proximal fibular fracture coexisting with a medial malleolar fracture or disruption of the deltoid ligament. Maisonneuve fractures are associated with partial or complete disruption of the syndesmosis.

Treatment of Maisonneuve fractures depends on stability of the ankle mortise.

·         Tillaux fracture: A Tillaux fracture describes a Salter-Harris (SH) type III injury of the anterolateral tibial epiphysis caused by extreme eversion and lateral rotation of the ankle. Incidence is highest in adolescents, usually those aged 12-14 years, because the fracture occurs after the medial aspect of the epiphyseal plate of the tibia closes but before the lateral aspect arrests.

Distinguish a Tillaux fracture from a triplane fracture. Triplane fracture is a combination of a SH II and III fracture and is more likely than a Tillaux fracture to require open reduction and internal fixation.

Bimalleolar fractures, termed Pott fractures, involve at least 2 elements of the ankle ring. These fractures should be considered unstable and require urgent orthopedic attention.

A trimalleolar, or Cotton, fracture involves the medial, lateral, and posterior malleoli. These fractures are considered unstable and require urgent orthopedic attention.

·         Snowboarder's fracture: With the popularity of snowboarding in the late adolescent and young adult population, it is likely the emergency physician will come across a fracture of the lateral process of the talus, the so-called snowboarding ankle fracture.

A combination of dorsiflexion and inversion of the ankle produces the lateral talar fracture.

A high index of suspicion should be used in snowboarders who complain of lateral ankle pain with a normal-appearing ankle radiograph. Computed tomography imaging is often required to diagnose a talus fracture.

·         Metacarpal fractures: Usually the result of punching something. The “Friday night fracture” with the little finger being most common affected.

·         Scapholunate ligament: Common in isolation or in association with fractures (especially distal radius). “Terry Thomas sign”, i.e. increase in the space between scaphoid and lunate on a clenched fist PA view.

Acute ruptures may be repaired but chronic injuries may require reconstruction or fusion.

·         Spiral fracture of the distal third of humerus with associated radial nerve palsy: Holstein-Lewis Fracture.

·         High velocity (RTA) or large crush injuries can result in a stove-in chest with a flail segment, i.e. multiple rib fractures, each fractured at two sites.

·         A toddler fracture is a fracture of the tibia in a child 9 months to 3 years old as a result of low-energy forces. Typically, these fractures have a spiral appearance and are not displaced. The fibula is rarely fractured. The child will have a limp or an inability to bear weight. Immobilization in a splint or cast for 3 weeks is the usual treatment.

·         A Stener lesion is characterized by displacement of the avulsed ulnar collateral ligament such that the adductor pollicis aponeurosis is interposed between the avulsed ligament and its insertion, effectively precluding healing. This requires surgical repair to prevent chronic instability.