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From the case: Charcot foot

Modality: X-ray
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From the case: Charcot's foot

Modality: X-ray
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From the case: Charcot joint

Modality: X-ray
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From thecase: Charcot joint

Modality: X-ray
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Imaging Different ia l Diagnos is

From the case: Pottdisease

Modality: CT
http://radiopaedia.org/cases/pott-disease-4http://radiopaedia.org/cases/pott-disease-4http://radiopaedia.org/cases/pott-disease-4http://radiopaedia.org/cases/pott-disease-4http://radiopaedia.org/cases/pott-disease-4http://radiopaedia.org/cases/pott-disease-4


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Chop ar t f rac tu re Dr Ayush Goel and Dr Jeremy Jones et al.

A Chopart fracture is a fracture/dislocation of the mid-tarsal joint (Chopart joint) of the foot,i.e. talonavicular and calcaneocuboid joints. The commonly fractured bones are the calcaneus , cuboid and navicular .

The foot is usually dislocated medially and superiorly as it is plantar flexed and inverted, usuallyas a result of high energy impact, e.g. fall from height or road traffic collision.

Where the foot is everted, lateral displacement occurs.

Etymology

It is named after Francois Chopart , French surgeon (1743-1795) Paris 1.

References

1. Hunter TB, Peltier LF, Lund PJ. Radiologic history exhibit. Musculoskeletal eponyms: who are those guys? Radiographics. 20 (3): 819-36. Radiographics (full text) - Pubmed citation 2. Haapamaki VV, Kiuru MJ, Koskinen SK. Ankle and foot injuries: analysis of MDCT findings. AJR Am J

Roentgenol. 2004;183 (3): 615-22. AJR Am J Roentgenol (full text) - Pubmed citation 3. Kumagai S, Fitzgibbons TC, Mcmullen ST et-al. Chopart's fracture dislocation: a case report and review

of the literature. Nebr Med J. 1996;81 (4): 116-9. - Pubmed citation

Synony ms & Alternat ive Spel l ings

Synonyms or A lternati ve Spell ing I nclude in L istings?

Chopart fracture dislocation
http://radiopaedia.org/users/drayushgoelhttp://radiopaedia.org/users/drayushgoelhttp://radiopaedia.org/users/drjermyhttp://radiopaedia.org/users/drjermyhttp://radiopaedia.org/users/drjermyhttp://radiopaedia.org/articles/missing?article%5Btitle%5D=mid-tarsal-jointhttp://radiopaedia.org/articles/missing?article%5Btitle%5D=mid-tarsal-jointhttp://radiopaedia.org/articles/missing?article%5Btitle%5D=mid-tarsal-jointhttp://radiopaedia.org/articles/missing?article%5Btitle%5D=calcaneushttp://radiopaedia.org/articles/missing?article%5Btitle%5D=calcaneushttp://radiopaedia.org/articles/missing?article%5Btitle%5D=calcaneushttp://radiopaedia.org/articles/missing?article%5Btitle%5D=cuboidhttp://radiopaedia.org/articles/missing?article%5Btitle%5D=cuboidhttp://radiopaedia.org/articles/missing?article%5Btitle%5D=navicularhttp://radiopaedia.org/articles/missing?article%5Btitle%5D=navicularhttp://radiopaedia.org/articles/missing?article%5Btitle%5D=navicularhttp://radiographics.rsna.org/content/20/3/819.fullhttp://radiographics.rsna.org/content/20/3/819.fullhttp://radiographics.rsna.org/content/20/3/819.fullhttp://www.ncbi.nlm.nih.gov/pubmed/10835130http://www.ncbi.nlm.nih.gov/pubmed/10835130http://www.ncbi.nlm.nih.gov/pubmed/10835130http://www.ajronline.org/cgi/content/full/183/3/615http://www.ajronline.org/cgi/content/full/183/3/615http://www.ajronline.org/cgi/content/full/183/3/615http://www.ncbi.nlm.nih.gov/pubmed/15333345http://www.ncbi.nlm.nih.gov/pubmed/15333345http://www.ncbi.nlm.nih.gov/pubmed/15333345http://www.ncbi.nlm.nih.gov/pubmed/8628450http://www.ncbi.nlm.nih.gov/pubmed/8628450http://www.ncbi.nlm.nih.gov/pubmed/8628450http://www.ncbi.nlm.nih.gov/pubmed/8628450http://www.ncbi.nlm.nih.gov/pubmed/15333345http://www.ajronline.org/cgi/content/full/183/3/615http://www.ncbi.nlm.nih.gov/pubmed/10835130http://radiographics.rsna.org/content/20/3/819.fullhttp://radiopaedia.org/articles/missing?article%5Btitle%5D=navicularhttp://radiopaedia.org/articles/missing?article%5Btitle%5D=cuboidhttp://radiopaedia.org/articles/missing?article%5Btitle%5D=calcaneushttp://radiopaedia.org/articles/missing?article%5Btitle%5D=mid-tarsal-jointhttp://radiopaedia.org/users/drjermyhttp://radiopaedia.org/users/drayushgoel


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From the case: Fracture of mid-tarsal joint (Chopart's joint)

Modality: CT
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From the case: Fracture of mid-tarsal joint (Chopart's joint)

Modality: CT
http://radiopaedia.org/cases/fracture-of-mid-tarsal-joint-choparts-jointhttp://radiopaedia.org/cases/fracture-of-mid-tarsal-joint-choparts-jointhttp://radiopaedia.org/cases/fracture-of-mid-tarsal-joint-choparts-jointhttp://radiopaedia.org/cases/fracture-of-mid-tarsal-joint-choparts-joint


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Plain f i lm

AP and lateral wrist x-rays usually suffice. The fracture appears extra articular, and usually proximal to the radioulnar joint. Dorsal angulation of the distal fracture fragment is present to avariable degree (as opposed to volar angulation of a Smith fracture ). There is also usually

impaction with resultant shortening of the radius. An associated ulnar styloid fracture is presentin up to 50% of cases.

Report checklist

In addition to noting the presence of a fracture a number of features should be sought andcommented upon:

fractureo degree of dorsal angulationo degree of impactiono degree and direction of displacemento location of the medial fracture line: does it involve the radioulnar jointo presence for intra-articular fractures

other fractureso ulnar styloido carpal bones

Treatment and prognos is

The vast majority of Colles fractures can be treated with closed reduction andcast immobilisation. The cast extends from below the elbow to the metacarpal heads and holdsthe wrist somewhat flexed and in ulnar deviation 4 - for those of you familiar with Australianrules football, this position is reminiscent of the the position adopted when holding a ball in

preparation for a kick. This cast is known as a Colles cast 4.

Open reduction and internal fixation should be considered when the fracture is unstable, and/orunsatisfactory closed reduction is achieved (e.g. >10 degrees dorsal angulation; >5 mmshortening; significant comminution) 1.

Complications include 1-3:

malunion resulting in dinner fork deformity median nerve palsy and post traumatic carpal tunnel syndrome reflex sympathetic dystrophy secondary osteoarthritis , more frequently seen in patients with intra-articular involvement EPL tendon tear

Etymology

Originally named by Abraham Colles (1773-1843) Irish surgeon, Dublin.
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References

1. Munk PL, Munk P, Ryan A. Teaching Atlas of Musculoskeletal Imaging. Thieme Medical Pub. (2007) ISBN:1588903729. Read it at Google Books - Find it at Amazon

2. Bohndorf K, Imhof H, Pope TL. Musculoskeletal Imaging, A Concise Multimodality Approach. GeorgeThieme Verlag. (2001) ISBN:1588900606. Read it at Google Books - Find it at Amazon

3. Reiser M, Baur-Melnyk A. Musculoskeletal Imaging. TIS. (2008) ISBN:3131493410. Read it at Google Books - Find it at Amazon

4. Maheshwari J. Essential Orthopaedics. Jaypee Brothers Medical Pub. (2012) ISBN:8184655428. Read itat Google Books - Find it at Amazon



Colles' fracture
http://books.google.com/books?vid=ISBN1588903729http://books.google.com/books?vid=ISBN1588903729http://books.google.com/books?vid=ISBN1588903729http://www.amazon.com/gp/product/1588903729?ie=UTF8&tag=radiopaediaor-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=1588903729http://www.amazon.com/gp/product/1588903729?ie=UTF8&tag=radiopaediaor-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=1588903729http://www.amazon.com/gp/product/1588903729?ie=UTF8&tag=radiopaediaor-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=1588903729http://books.google.com/books?vid=ISBN1588900606http://books.google.com/books?vid=ISBN1588900606http://books.google.com/books?vid=ISBN1588900606http://www.amazon.com/gp/product/1588900606?ie=UTF8&tag=radiopaediaor-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=1588900606http://www.amazon.com/gp/product/1588900606?ie=UTF8&tag=radiopaediaor-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=1588900606http://www.amazon.com/gp/product/1588900606?ie=UTF8&tag=radiopaediaor-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=1588900606http://books.google.com/books?vid=ISBN3131493410http://books.google.com/books?vid=ISBN3131493410http://books.google.com/books?vid=ISBN3131493410http://books.google.com/books?vid=ISBN3131493410http://www.amazon.com/gp/product/3131493410?ie=UTF8&tag=radiopaediaor-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=3131493410http://www.amazon.com/gp/product/3131493410?ie=UTF8&tag=radiopaediaor-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=3131493410http://www.amazon.com/gp/product/3131493410?ie=UTF8&tag=radiopaediaor-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=3131493410http://books.google.com/books?vid=ISBN8184655428http://books.google.com/books?vid=ISBN8184655428http://books.google.com/books?vid=ISBN8184655428http://books.google.com/books?vid=ISBN8184655428http://www.amazon.com/gp/product/8184655428?ie=UTF8&tag=radiopaediaor-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=8184655428http://www.amazon.com/gp/product/8184655428?ie=UTF8&tag=radiopaediaor-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=8184655428http://www.amazon.com/gp/product/8184655428?ie=UTF8&tag=radiopaediaor-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=8184655428http://www.amazon.com/gp/product/8184655428?ie=UTF8&tag=radiopaediaor-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=8184655428http://books.google.com/books?vid=ISBN8184655428http://books.google.com/books?vid=ISBN8184655428http://www.amazon.com/gp/product/3131493410?ie=UTF8&tag=radiopaediaor-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=3131493410http://books.google.com/books?vid=ISBN3131493410http://books.google.com/books?vid=ISBN3131493410http://www.amazon.com/gp/product/1588900606?ie=UTF8&tag=radiopaediaor-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=1588900606http://books.google.com/books?vid=ISBN1588900606http://www.amazon.com/gp/product/1588903729?ie=UTF8&tag=radiopaediaor-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=1588903729http://books.google.com/books?vid=ISBN1588903729


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Colles' fracture Colles' fracture of the left wrist with associated ulnar styloid fracture. Author: Lucien Monfils


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From the case: Distalradial fracture

Modality: X-ray
http://radiopaedia.org/cases/distal-radial-fracturehttp://radiopaedia.org/cases/distal-radial-fracturehttp://radiopaedia.org/cases/distal-radial-fracturehttp://radiopaedia.org/cases/distal-radial-fracturehttp://radiopaedia.org/cases/distal-radial-fracturehttp://radiopaedia.org/cases/distal-radial-fracture


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From the case: Colles fracture

Modality: X-ray
http://radiopaedia.org/cases/colles-fracture-1http://radiopaedia.org/cases/colles-fracture-1http://radiopaedia.org/cases/colles-fracture-1http://radiopaedia.org/cases/colles-fracture-1


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From the case: Distal radial fracture (Colles fracture)

Modality: X-ray
http://radiopaedia.org/cases/distal-radial-fracture-colles-fracturehttp://radiopaedia.org/cases/distal-radial-fracture-colles-fracturehttp://radiopaedia.org/cases/distal-radial-fracture-colles-fracture


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From the case: Distal radial fracture (Colles fracture)

Modality: X-ray
http://radiopaedia.org/cases/distal-radial-fracture-colles-fracturehttp://radiopaedia.org/cases/distal-radial-fracture-colles-fracturehttp://radiopaedia.org/cases/distal-radial-fracture-colles-fracture


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Modality: X-ray
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Modality: X-ray
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From the case: Distal radial fracture (Colles' fracture)

Modality: X-ray
http://radiopaedia.org/cases/distal-radial-fracture-colles-fracture-1http://radiopaedia.org/cases/distal-radial-fracture-colles-fracture-1http://radiopaedia.org/cases/distal-radial-fracture-colles-fracture-1http://radiopaedia.org/cases/distal-radial-fracture-colles-fracture-1


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From the case: Distal radial fracture

Modality: X-ray
http://radiopaedia.org/cases/distal-radial-fracture-4http://radiopaedia.org/cases/distal-radial-fracture-4http://radiopaedia.org/cases/distal-radial-fracture-4http://radiopaedia.org/cases/distal-radial-fracture-4


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From the case: Distal radial fracture

Modality: X-ray
http://radiopaedia.org/cases/distal-radial-fracture-4http://radiopaedia.org/cases/distal-radial-fracture-4http://radiopaedia.org/cases/distal-radial-fracture-4http://radiopaedia.org/cases/distal-radial-fracture-4


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Laug e-Hans en class i f icat ion Anklefractu re (c lass i f icat ion ) - Laug e-Hans en Dr Jeremy Jones and Radswiki et al.

The Lauge-Hansen classification system is sometimes used for the classification of anklefractures. However, the Weber classification system is more often cited.

It uses 2 word descriptors. The first word describes the position of the foot, the second worddescribes the motion of the foot (talus) with respect to the leg.

supination-adduction (Weber A) supination-external rotation (Weber B)

o stage 1: the anteroinferior tibiofibular ligament is torn or avulsedo stage 2: the talus displaces and fractures the fibula in an oblique or spiral fracture, starting at the

joint.o stage 3: tear of the posteroinferior tibiofibular ligament or fracture posterior malleoluso stage 4: tear of the deltoid ligament or transverse fracture medial malleolus

pronation-abduction (Weber C) pronation-external rotation (Weber C) pronation-dorsiflexion (Weber C)


Synonyms or A lternative Spell ing I nclude in L istings?

Lauge-Hansen classification

References

1. Browner BD. Skeletal trauma, basic science, management, and reconstruction. W B Saunders Co. (2003) ISBN:0721691757. Read it at Google Books - Find it at Amazon

2. Hunter TB, Peltier LF, Lund PJ. Radiologic history exhibit. Musculoskeletal eponyms: who are those guys? Radiographics. 20 (3): 819-36. Radiographics (full text) - Pubmed citation

3. Skinner HB. Current diagnosis & treatment in orthopedics. McGraw-Hill Medical. (2006) ISBN:0071438335. Read it at Google Books - Find it at Amazon


Synonyms or Al ternative Spell ing I nclude in L istings?

Danis-Weber classification

Weber classification
http://radiopaedia.org/articles/ankle-fracture-classification-lauge-hansenhttp://radiopaedia.org/users/drjermyhttp://radiopaedia.org/users/drjermyhttp://radiopaedia.org/users/radswikihttp://radiopaedia.org/users/radswikihttp://radiopaedia.org/users/radswikihttp://radiopaedia.org/articles/ankle-fracture-classification-weberhttp://radiopaedia.org/articles/ankle-fracture-classification-weberhttp://radiopaedia.org/articles/ankle-fracture-classification-weberhttp://books.google.com/books?vid=ISBN0721691757http://books.google.com/books?vid=ISBN0721691757http://books.google.com/books?vid=ISBN0721691757http://www.amazon.com/gp/product/0721691757?ie=UTF8&tag=radiopaediaor-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=0721691757http://www.amazon.com/gp/product/0721691757?ie=UTF8&tag=radiopaediaor-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=0721691757http://www.amazon.com/gp/product/0721691757?ie=UTF8&tag=radiopaediaor-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=0721691757http://radiographics.rsna.org/content/20/3/819.fullhttp://radiographics.rsna.org/content/20/3/819.fullhttp://radiographics.rsna.org/content/20/3/819.fullhttp://www.ncbi.nlm.nih.gov/pubmed/10835130http://www.ncbi.nlm.nih.gov/pubmed/10835130http://www.ncbi.nlm.nih.gov/pubmed/10835130http://books.google.com/books?vid=ISBN0071438335http://books.google.com/books?vid=ISBN0071438335http://books.google.com/books?vid=ISBN0071438335http://www.amazon.com/gp/product/0071438335?ie=UTF8&tag=radiopaediaor-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=0071438335http://www.amazon.com/gp/product/0071438335?ie=UTF8&tag=radiopaediaor-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=0071438335http://www.amazon.com/gp/product/0071438335?ie=UTF8&tag=radiopaediaor-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=0071438335http://www.amazon.com/gp/product/0071438335?ie=UTF8&tag=radiopaediaor-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=0071438335http://books.google.com/books?vid=ISBN0071438335http://www.ncbi.nlm.nih.gov/pubmed/10835130http://radiographics.rsna.org/content/20/3/819.fullhttp://www.amazon.com/gp/product/0721691757?ie=UTF8&tag=radiopaediaor-20&linkCode=as2&camp=1789&creative=9325&creativeASIN=0721691757http://books.google.com/books?vid=ISBN0721691757http://radiopaedia.org/articles/ankle-fracture-classification-weberhttp://radiopaedia.org/users/radswikihttp://radiopaedia.org/users/drjermyhttp://radiopaedia.org/articles/ankle-fracture-classification-lauge-hansen


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From the case: Weber A fracture

Modality: X-ra
http://radiopaedia.org/cases/weber-a-fracturehttp://radiopaedia.org/cases/weber-a-fracturehttp://radiopaedia.org/cases/weber-a-fracturehttp://radiopaedia.org/cases/weber-a-fracture


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From the case: Weber B fracture and ORIF

Modality: X-ray
http://radiopaedia.org/cases/weber-b-fracture-and-orifhttp://radiopaedia.org/cases/weber-b-fracture-and-orifhttp://radiopaedia.org/cases/weber-b-fracture-and-orifhttp://radiopaedia.org/cases/weber-b-fracture-and-orif


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Weber ankle fracture classification Weber C fracture. Note the widening of medial joint space.


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From the case: Trimalleolar ankle fracture

Modality: X-ray
http://radiopaedia.org/cases/trimalleolar-ankle-fracturehttp://radiopaedia.org/cases/trimalleolar-ankle-fracturehttp://radiopaedia.org/cases/trimalleolar-ankle-fracturehttp://radiopaedia.org/cases/trimalleolar-ankle-fracture


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From the case: Weber C fracture of the ankle

Modality: X-ray
http://radiopaedia.org/cases/weber-c-fracture-of-the-anklehttp://radiopaedia.org/cases/weber-c-fracture-of-the-anklehttp://radiopaedia.org/cases/weber-c-fracture-of-the-ankle


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Essex-Lo pres t i f rac tu re-d is lo ca t ion Dr Jeremy Jones and Dr Frank Gaillard et al.

Essex-Lopresti fracture-dislocations comprise a comminuted fracture of the radialhead accompanied by dislocation of the distal radio-ulnar joint.

Etymology

Named after Peter Gordon Essex-Lopresti (1916-1951), a trauma surgeon at Birminghamaccident hospital, England 2.

References


2. Peter Gordon Essex-Lopresti (1916 - 1951)



Essex lopresti fracture dislocation
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Freiberg dis ease Dr Tim Luijkx and Dr Jeremy Jones et al.

Freiberg disease (also known as Freiberg infraction ) is osteochondrosis of metatarsal heads. Ittypically affects the 2 nd metatarsal head (the third and fourth may also be affected). It can be

bilateral in up to 10% of cases.

Epidemio logy

It is commoner in women aged 10-18 (male to female ratio of 1:3).

Clinical presentat ion

Clinically they present with pain (sometimes a painful limp), swelling and tenderness.

Pathophys io logy

The cause of Freiberg infraction is controversial and is probably multifactorial.

A traumatic insult in the form of either acute or repetitive injury and vascular compromise arethe most popular theories, and as it is more commonly seen in women particularly duringadolescence, high-heeled shoes have been postulated as a possible causative factor.

Histologically Freiberg infraction is characterised by collapse of the subchondral bone,osteonecrosis, and cartilaginous fissures 1.

Radiographic features

Plain f i lm

These can be split into early and late features:

Early

flattening and cystic lesions of the affected metatarsal head widening of the metatarsophalangeal (MTP) joint
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From the case: Freiberg infraction

Modality: X-ray
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Fromthe case: Freiberg's infraction

Modality: X-r
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Fromthe case: Freiberg's infraction

Modality: X-ray
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From thecase: Freiberg's infraction

Modality: X-ray
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Osteonecrosis 2nd Metatarsal Head


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Fromthe case: Osteonecrosis of 2nd metatarsal head.
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From the case: Freiberg's Infraction
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Modality: X-ray
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From the case: Freibergdisease

Modality: X-ray
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Galeazzi f ractu re-dis loc at ion Dr Frank Gaillard et al.

Galeazzi fracture-dislocations consist of fracture of the radius with dislocation of distalradioulnar joint and an intact ulna . A Galeazzi equivalent fracture is a distal radial fracture with adistal ulnar physeal fracture 3.

Epidemio logy

Galeazzi fractures are primarily encountered in children, with a peak incidence of 9-12 years of

age3

. In adults, it is estimated to account for ~7% forearm fractures4

.

Mechanism

Typically Galeazzi fracture-dislocations occur following a fall on an outstretched hand (FOOSH) with a flexed elbow.


Galeazzi fractures are classified according to the position of the distal radius:

type I - dorsal displacement type I I - volar displacement

Plain f i lm

Plain films are usually sufficient for diagnosis and management planning, however goodquality orthogonal views are needed to correctly identify and characterise displacement. Featuresinclude:

radial shaft fractureo commonly at the junction of the middle and distal thirdo dorsal angulation

dislocation of the distal radioulnar joint radial shortening may occur and if greater than 10mm, suggests complete disruption of the interosseous

membrane

Report checklist

In addition to stating the presence of the radial fracture and distal radio-ulnar joint dislocation anumber of features should be sought and commented upon.
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radial fractureso locationo angulationo degree of shortening (see above)

distal radioulnar joint dislocationo direction


These fractures are unstable and operative fixation is usually required to reduce and fix the radialfracture, and the arm is immobilised in pronation 4-5. The exact mode of fixation depends on thelocation of the radial fracture 5:

diaphysis - elastic nail metaphyseal-diaphyseal junction - plate and screw distal radius - K-wire

In Galeazzi equivalent fractures, ulnar physeal arrest is frequent, seen in 55% of cases 3.

Etymology

First described by Riccardo Galeazzi (1866-1952), an orthopaedic surgeon from Italy in 19341,4 .

Many people consider the Galeazzi and Piedmont fractures as the same injury. However, somestate that the latter is an isolate radial fracture without distal radioulnar dissociation.The Piedmont fracture was so named by the Piedmont Orthopaedic Society.

o [+]

References


2. Sikdar T, Redla S, Strickland, Case 164, Galeazzi fracture-dislocation, eurorad case files 3. Egol KA, Koval KJ, Zuckerman JD. Handbook of Fractures. (2010) ISBN:1605477605. Read it at

Google Books - Find it at Amazon 4. Saffar P, Cooney WP. Fractures of the Distal Radius. Informa HealthCare. (1995) ISBN:1853171786.

Read it at Google Books - Find it at Amazon 5. Benson M, Fixsen J, MacNicol M. Children's Orthopaedics and Fractures. Springer Verlag. (2010)

ISBN:1848826109. Read it at Google Books - Find it at Amazon



Galeazzi fracture dislocation
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Galeazzi fracture

Reverse Monteggia fracture dislocation

From the case: Galeazzi fracture

Modality: X-ray
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From the case: Galeazzi fracture

Modality: X-ray
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From the case: Galeazzi fracture-dislocation

Modality: X-ray
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From the case: Galeazzi fracture-dislocation

Modality: X-ray
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Goyr and f rac ture Dr Aditya Shetty and Dr Jeremy Jones et al.

Goyrand fracture is another name for a Smith fracture (reverse Barton fracture) and is predominantly used in France or French-influenced countries.

For a discussion of the this fracture refer to the article on Smith fractures .

His to ry and e tymology

Named after Jean-Gaspard-Blaise Goyrand : French physician (1746-1814)1

References

1. Latil F, Hueston JT. [Goyrand J.G.B (1803-1866), surgeon and academician from Aix en Provence]. Ann Chir Plast Esthet. 1992;37 (5): 574-8. - Pubmed citation



Goyrand's fracture
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Hil l-Sach s les ion Dr Frank Gaillard et al.

A Hill-Sachs lesion usually results from recurrent anterior shoulder dislocation with resultant posterolateral humeral head compression fracture as the humeral head comes to rest against theanteroinferior part of the glenoid. It is often associated with a Bankart lesion of the glenoid.

In addition to being acutely painful at the time of dislocation, it may promote future dislocation /subluxation due to the lever-like effect of the defect during external rotation 4.

Radiographic appearance

Hill-Sachs lesions may be difficult to appreciate on x-rays, frequently requiring CT or MRI forfull characterisation. When a Hill-Sachs lesion is identified careful assessment of the anteriorglenoid rim and labrum should be performed to identify a potential Bankart lesion .

Plain f i lm

Best seen following re-location of the joint, and better appreciated on internal rotation views. Itappears as a sclerotic vertical line running from the top of the humeral head towards the shaft. Iflarge then a wedge defect may be evident.

CT and MRI

Both MRI and CT are very sensitive to this lesion, which appears as a region of flattening or awedge shaped defect (with bone marrow oedema on MRI acutely) seen involving the

posterolateral humeral head above the level of the coracoid. This is usually seen in the mostsuperior few slices, were the humeral head should be rounded. It is important to note that below

the level of the coracoid the humeral head normally flattens out posterolaterally (sometimestermed Pseudo-Hill-Sachs lesion ), and this should not be misinterpreted as a Hill-Sachs lesion2,4 .


The bony defect itself does not require treatment, however the associated glenohumeralinstability and often co-existent anterior labral injuries often do require surgical repair.
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The bony defect can also be treated with bone grafting or placement of soft tissue within thedefect. This is generally reserved for large defects 6-7.

The Connolly procedure is performed by an open posterior approach and involves transferringthe infraspinatus with a portion of greater the tuberosity into the defect, and rendering the defect

extra-articular6-7

.

Alternatively soft tissue transfer can be performed arthroscopically 6.


It was first described in 1940 by H A Hill and M D Sachs 3.

References

1. Manaster BJ, Disler DG, May DA et-al. Musculoskeletal imaging, the requisites. Mosby Inc. (2002)

ISBN:0323011896. Read it at Google Books - Find it at Amazon 2. Zlatkin MB. MRI of the shoulder. Lippincott Williams & Wilkins. (2003) ISBN:0781715903. Read it atGoogle Books - Find it at Amazon

3. Hill, Harold A.; Sachs, Maurice D. The Grooved Defect of the Humeral Head Radiology. 35 (6): 690.doi:10.1148/35.6.690

4. Workman TL, Burkhard TK, Resnick D et-al. Hill-Sachs lesion: comparison of detection with MRimaging, radiography, and arthroscopy. Radiology. 1992;185 (3): 847-52. Radiology (abstract) - Pubmedcitation

5. Manaster BJ, Disler DG, May DA et-al. Musculoskeletal imaging, the requisites. Mosby Inc. (2002) ISBN:0323011896. Read it at Google Books - Find it at Amazon

6. Levine WN, Blaine TA, Ahmad CS. Minimally Invasive Shoulder and Elbow Surgery. Informa HealthCare. (2007) ISBN:0849372151. Read it at Google Books - Find it at Amazon

7. Iannotti JP, Williams GR. Disorders of the shoulder, diagnosis & management. Lippincott Williams &

Wilkins. (2007) ISBN:0781756782. Read it at Google Books - Find it at Amazon


Synonyms or A lternative Spell ing I nclude in L istings?

Hill Sach's deformity

Hill-Sachs lesions

Hill Sachs deformities

Hill Sachs lesion
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Normal shoulder AP


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Normal shoulder external rotation


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Normal shoulder internal rotation


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Normal shoulder


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From the case: Hill-Sachs lesion

Modality: X-ray
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Modality: X-ray
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Modality: X-ray
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Chauffeur f ractu re Dr Ayush Goel and Dr Jeremy Jones et al.

Chauffeur fractures (also known as Hutchinson fractures or backfire fractures) isan intraarticular fracture of the radial styloid process. The radial styloid is within the fracturefragment, although the fragment can vary markedly in size 3.

Mechanism

These injuries are sustained either from direct trauma typically a blow to the back of the wrist or

from forced dorsiflexion and abduction.

The former accounts for its name; trying to start an old-fashioned car with a hand cranksometimes resulted in the crank rapidly spinning backwards (backfire) out of the driver's graspand striking the back of the wrist 5.

The later occurs as the scaphoid forcibly impacts upon the radial styloid and can be consideredan avulsion fracture with the radiocarpal ligaments remaining attached to the radial styloid 7.


Plain films usually suffice in the assessment of chauffeur fractures. Along with other distal radialfractures, the AP film can also be used to classify these fractures according to the Frykmanclassification of distal radial fractures . Chauffeur fractures are considered type III fractures.

Plain f i lm

The fracture extends proximally in a variably oblique direction (from essentially transverse toalmost sagittal) from the distal radial articular surface through the lateral cortex of the distalradius, thus separating the radial styloid from the rest of the radius 4-5. Although oftenthe fracture is undisplaced 5, depending how how sagittal the fracture orientation is, variable

proximal migration of the fracture occurs, with an articular step which comes into contact with

the scaphoid4.

A number of associated injuries are frequently encountered and may significantly impact onmanagement:

scapholunate dissociation: this is especially true when the fracture line involves the articlular surface nearthe scapholunate interval7

trans-scaphoid perilunate dislocation
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ulnar styloid fracture: equates toa Frykman type IV fracture

Report checklist

In addition to reporting the presence of the fracture a number of features should be sought and in

many instances commented upon as relevant negatives. fracture

o direction: transverse/oblique/sagittalo where along the articular surface it begins (especially relative to the scapholunate interval)o displacement and articular step-off and gap distanceo any comminution

associated injurieso scapholunate joint spaceo scaphoid fractureo carpal alignment (esp. perilunate)o ulnar styloid fracture


Although these fractures are often undisplaced, they are relatively unstable and often benefitfrom percutaneous lag-screw fixation 6.

Etymology

It was originally named by Jonathan Hutchinson (1828-1913) who was a British surgeon. Itsother names derive from the typical occupation of people who sustained this injury due to directtrauma from starting a car with a crank. It is also known as backfire fracture or lorry driverfracture 1.

It is interesting to note that the word chauffeur comes from the french for s o m eo n e w h o

warms the car engine.

References

1. Lee P, Hunter TB, Taljanovic M. Musculoskeletal colloquialisms: how did we come up with thesenames? Radiographics. 24 (4): 1009-27. doi:10.1148/rg.244045015 - Pubmed citation

2. SPRINGER B. Emergency Radiology, Imaging and Intervention. (2010) ISBN:3642065686. Read it atGoogle Books - Find it at Amazon

3. Goldfarb CA, Yin Y, Gilula LA et-al. Wrist fractures: what the clinician wants to know. Radiology.2001;219 (1): 11-28. Radiology (full text) - Pubmed citation

4. Saffar P, Cooney WP. Fractures of the Distal Radius. Informa HealthCare. (1995) ISBN:1853171786. Read it at Google Books - Find it at Amazon

5. Yochum TR, Rowe LJ. Essentials of Skeletal Radiology. Philadelphia, Pa. : Lippincott Williams &Wilkins, c2005. (2005) ISBN:0781739462. Read it at Google Books - Find it at Amazon

6. Schatzker J, Tile M. The Rationale of Operative Fracture Care. Springer Verlag. (2005) ISBN:3540228500. Read it at Google Books - Find it at Amazon

7. Robinson P. Essential Radiology for Sports Medicine. Springer Verlag. (2010) ISBN:1441959726. Readit at Google Books - Find it at Amazon
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tyloid-fracture


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Hutchinson's fracture

Chauffeur's fracture

Lorry driver fracture

Lorry driver's fracture

Backfire fracture

Hutchinson fracture


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From the case: Chauffeur fracture

Modality: X-ray
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Modality: X-ray
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From the case: Chauffeur's fracture

Modality: X-ray
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From the case: Chauffeur's fracture

Modality: X-ray
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Modality: X-ray
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Jefferso n f rac tu re Dr Ayush Goel and Rishi Agrawal et al.

Jefferson fracture is the eponymous name given to a burst fracture of C1. It was originallydescribed as a 4 part fracture with double fractures through the anterior and posterior arches, but3-part and 2-part fractures have also been described.

Pathology

Mechanism

A typical mechanism of injury is diving head first into shallow water. Axial loading along theaxis of the cervical spine results in the occipital condyles being driven into the lateral masses ofC1. The Jefferson fracture is not normally associated with neurological deficet although spinalcord injury may occur if there is a retropulsed fragment .

Assoc ia t ions

50% are associated with other C-spine injuries 33% are associated with a C2 fracture 25-50% of young children have concurrent head injury vertebral artery injury5 extra-cranial cranial nerve injury6


Plain f i lm

Radiographs will show asymmetry in the odontoid view with displacement of the lateralmass(es) away from the odontoid peg . A distance of greater than 6 mm suggests ligamentousinjury.

CT

CT demonstrates the fracture line which usually involves both the anterior and posterior arches.If there is injury to the transverse atlantal ligament , the atlantodens interval (ADI) increases. Thenormal ADI in the adult population is less than 3 mm; in paediatric populations, the normaldistance is less than 5 mm.

MRI
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The fracture will not be seen as well as with CT. However, localised soft-tissue injury will beapparent. Pre-vertebral haemorrhage or oedema will identify injury at the level of C1/2.Ligamentous injury will also be demonstrated. A fat-sat T2 sequence is useful in the traumasetting to help distinguish abnormal soft-tissue injury from normal fat.


Jefferson fractures are typically treated conservatively (hard collar immobilisation) provided thetransverse atlantal ligament is considered intact (no widening of the atlanto-dens interval orintact ligament visualised on MRI).

In cases where the ligament is thought to be disrupted, the injury is considered unstable and moreaggressive management is usually required 7. This includes halo immobilisation, posterior C1-C2lateral mass internal fixation or transoral internal fixation.


Named by Sir Geoffrey Jefferson (1886-1961), neurosurgeon from the UK 4.

References

1. Lustrin ES, Karakas SP, Ortiz AO et-al. Pediatric cervical spine: normal anatomy, variants, and trauma. Radiographics. 23 (3): 539-60. doi:10.1148/rg.233025121 - Pubmed citation


3. Jefferson G. British Journal of Surgery. 1919;7 (27): 407-22 doi:10.1002/bjs.1800072713 4. Sir Geoffrey Jefferson from whonamedit.com, the dictionary of medical eponyms. Sir Geoffrey Jefferson 5. Muratsu H, Doita M, Yanagi T et-al. Cerebellar infarction resulting from vertebral artery occlusion

associated with a Jefferson fracture. J Spinal Disord Tech. 2005;18 (3): 293-6. J Spinal Disord Tech (link) - Pubmed citation 6. Connolly B, Turner C, Devine J et-al. Jefferson fracture resulting in Collet-Sicard syndrome. Spine.

2000;25 (3): 395-8. Spine (link) - Pubmed citation 7. Norton JA, Barie PS, Bollinger R. Surgery, basic science and clinical evidence. Springer Verlag. (2008)

ISBN:0387308008. Read it at Google Books - Find it at Amazon



Burst fracture of C1

C1 burst fracture
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From the case: Jefferson fracture

Modality: X-ray
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Modality: X-ray
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From the case: Jefferson fracture with extension teardrop

Modality: X-ray
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Modality: X-ray
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Modality: X-ray
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Jo nes f rac tu re Dr Abhijit Datir et al.

Jones fractures occur at the base of the fifth metatarsal .

Pathology

It is a transverse fracture at the base of the fifth metatarsal, 1.5 to 3 cm distal to the proximaltuberosity at the metadiaphyseal junction, without distal extension.

Mechanism

The fracture is believed to occur as a result of significant adduction force to the forefoot with theankle in plantar flexion 5.


Plain film / CT

A Jones fracture is located at the metadiaphyseal junction, approximately 2cm (1.5-3cm) fromthe tip of the 5 th metatarsal, and has a predominantly horizontal course. It should not extend

distally, nor should it extend to involve the articular surfaces.


In contrast to avulsion fractures, Jones fractures are prone to non-union (with rates as high as 30-50%) and almost always take longer than two months heal 2.

As displacement of the fracture can be increased with persistent weight bearing, immobilizationis important as part of the initial therapy, with a non-weight bearing cast for 6-8 weeks.

Internal fixation and even bone grafting may be required in cases of non-union, or where the

fracture is significantly displaced.

Etymology

It was first described by Sir Robert Jones in 1902 3.
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Different ia l d iagnos is

A number of fractures occur at the base of the 5 th metatarsal (see fractures of the proximal fifthmetatarsal ) as well as entities which mimic fractures. These include:

stress fracture of the 5

th

metatarsal avulsion fracture of the proximal 5th metatarsal os peroneum normal apophysis of the proximal 5th metatarsal Iselin disease (apophysitis)

References

1. Chuckpaiwong B, Queen RM, Easley ME et-al. Distinguishing Jones and proximal diaphyseal fracturesof the fifth metatarsal. Clin. Orthop. Relat. Res. 2008;466 (8): 1966-70. doi:10.1007/s11999-008-0222-7 - Free text at pubmed - Pubmed citation

2. Pao DG, Keats TE, Dussault RG. Avulsion fracture of the base of the fifth metatarsal not seen onconventional radiography of the foot: the need for an additional projection. AJR Am J Roentgenol.2000;175 (2): 549-52. AJR Am J Roentgenol (full text) - Pubmed citation

3. Jones R. I. Fracture of the Base of the Fifth Metatarsal Bone by Indirect Violence. Ann. Surg. 1902;35(6): 697-700.2. - Free text at pubmed - Pubmed citation

4. Watson F. The Life of Sir Robert Jones. Ayer Co Pub. (1980) ISBN:0405131356. Read it at Google Books - Find it at Amazon

5. Theodorou DJ, Theodorou SJ, Kakitsubata Y et-al. Fractures of proximal portion of fifth metatarsalbone: anatomic and imaging evidence of a pathogenesis of avulsion of the plantar aponeurosis and the short peroneal muscle tendon. Radiology. 2003;226 (3): 857-65. doi:10.1148/radiol.2263020284 - Pubmedcitation


Synonyms or Al ternative Spell ing I nclude in L istings? Jones' fracture

Jones fractures
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eponymous fractures 1

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