FRACTURE NOMENCLATURE Page 1 of 7
Fracture Nomenclature
Fatigue Abnormal stress to a bone with normal elastic resistance
Insufficiency Normal stress to a bone with abnormal elastic resistance
Osteochondritis Fragmentation and possible separation of portion of articular surface
dissecans Most typical location is condylar surfaces of distal femur
Spine
Jeffersons o Ring fracture of C1
o Compression force from blow to vertex of head
Fractures of
Odontoid Process
Hangmans o Bilateral pedicle or pars fractures of C2
o Hyperextension and traction injury
Burst o Same mechanism as Jeffersons fracture, but involving C3-C7
(Compression) o Axial compression resulting in comminution of vertebral body
Fracture o Bone fragments in spinal canal are common
Flexion Teardrop o Most severe C-spine injury
o Unstable flexion fracture
o Results from severe flexion force
o Clinical acute anterior cord syndrome
o Completely unstable
Extension o Avulsion fracture of anteroinferior corner of axis
Teardrop o Hyperextension
Clay-shovelers o Avulsion fracture of spinous process
Wedge Fracture o Compression fracture resulting from flexion; stable
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Chance o (Lap seatbelt fracture, usually at L2 or L3)
Distraction from anterior hyperflexion across a
restraining lap seatbelt
o Horizontal fracture through soft tissues and/or bone
of TL spine:
o Horizontal splitting of vertebra
o Horizontal disruption of intervertebral disk
o Rupture of ligaments
o More than 50% of patients have associated small
bowel and colon injuries
Face
Le Fort I o Nasal septum (vomer and septal cartilage)
Floating Palate o Medial, anterior, lateral, posterior walls of maxillary
sinus
o Pterygoid plates of sphenoid
Le Fort II o Nasal bone and nasal septum
Floating Maxilla o Frontal process of maxilla
o Medial orbital wall (ethmoid, lacrimal, palatine)
o Floor of orbit (inferior orbital fissure and canal)
o Infraorbital rim
o Anterior, lateral, posterior wall of maxillary sinus
o Pterygoid plates of sphenoid
o Zygomatic arches not included
Le Fort III o Nasal bone and septum
Floating Face o Frontal process of maxilla
o Medial wall of orbit (lacrimal, ethmoid, palatine)
o Infraorbital fissure
o Lateral wall of orbit
o Zygomaticofrontal suture
o Zygomatic arch
o Pterygoid plates of sphenoid
Acromioclavicular Separation
o Most commonly result from athletic injury to AC joint
Direct blow to AC joint (e.g., football)
Severe arm traction
Fall on hand or elbow with arm flexed 90 degree
Grade I o Mild sprain; normal radiograph
Grade II o Moderate sprain; increased AC distance; normal CC distance
Grade III o Severe sprain; increased AC and CC distance
Grade IV o Total dislocation; clavicle displaced superoposteriorly into the
trapezius
Grade V: o Total dislocation; clavicle displaced superiorly into neck
Grade VI: o Total dislocation; clavicle displaced inferiorly to subacromial or
subcoracoid position
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Shoulder
Anterior o Most common type (95%) of dislocation
Dislocation o Usually due to indirect force from abduction,
external rotation, and extension
o Humeral head inferior and medial to glenoid
o Bulbous distortion of the scapulohumeral arch
(Moloney's arch)
Hill-Sachs o Posterior-superior and lateral of
Lesion humeral head, (best seen on AP view with internal
rotation)
Bankart Lesion o Antero-inferior of glenoid (may require CT)
Posterior o Less common (5%); usually due to direct or indirect
Dislocation force
o Humeral head lies superior to glenoid
o Sharp angle of the scapula-humeral arch (Moloney's
arch)
o Best seen on axillary view
o 40 posterior oblique (Grashey view) may be
needed: loss of glenohumeral space diagnostic
o Fixed in internal rotation
Trough Sign o Linear impaction fracture of anterior humeral head
o Compression fracture of anterior humeral surface, 15% (best seen on AP view with
external rotation or axillary view)
Reverse o Fracture of posterior glenoid rim
Bankart Lesion
Inferior Dislocation o Luxatio erecta; humeral head is located below the glenoid and the shaft of the
humerus is fixed in extreme abduction
Combined Radius-Ulna Fracture-
Dislocations
Monteggia ulna o Ulnar shaft fracture and radial head dislocation
(MU) I o Fracture of middle or upper 1/3 of ulna w/
anterior dislocation of radial head & anterior
angulation of ulna (65%)
II o Fracture of middle or upper 1/3 of ulna with
posterior dislocation of radial head and
posterior angulation of ulna (18%)
III o Fracture of ulna just distal to coronoid process
w/ lateral dislocation of radial head (16%)
IV o Fracture of upper or middle 1/3 of ulna with
anterior dislocation of radial head and fracture
of upper 1/3 of radius below bicipital tuberosity
(1%)
Galeazzi radius o Distal radial shaft fracture and distal radioulnar
(GR) dislocation
Essex-Lopresti o Comminuted radial head fracture and distal
radioulnar subluxation/dislocation
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Wrist
Colles o Distal radius fracture, dorsal angulation
Smiths o Distal radius fracture, volar angulation
Bartons o Intraarticular distal radial fracture/dislocation
Bennetts o Fracture-dislocation of base of first metacarpal
Rolando o Comminuted Bennetts fracture
th th
Boxers o 4 or 5 MCP shaft or neck fracture
Gamekeepers st
o Ulnar collateral ligament injury of 1 MCP joint
thumb (skiers)
Chauffeurs
o Intraarticular fracture of radial styloid
(Hutchinsons)
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Pelvis
Duverneys o Iliac wing
Malgaignes o SI joint or sacrum and both ipsilateral pubic rami
Bucket-handle o SI joint or sacrum and both contralateral pubic rami
Straddle o Both obturator rings (all four pubic rami)
Femoral Neck
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Lower Extremity
Slipped Capital o Slippage observed most typically in overweight
Femoral Epiphysis children, boys 10-17 years > girls of 8-15 years
o Avulsion fracture of lateral tibial condyle; associated
Segond
w/ ACL injury
Bumper o Intaarticular fracture of tibial condyle
Pilon o Intraarticular comminuted distal tibial fracture
o Salter-Harris III of lateral distal tibia (due to later
Tillaux
epiphyseal fusion)
Triplane o Salter-Harris III/IV of distal tibia
Wagstaffe-Le Fort o Avulsion of medial margin distal fibula
Dupuytrens o Fracture of fibula above tibiofibular ligament
o Proximal fibular fracture and disrupted ankle mortise
Maisonneuves
or medial malleolar fracture
Feet
o Calcaneal fracture
Lovers
o Results from axial load (fall from height)
th
Jones (dancers) o Fracture of proximal 5 metatarsal shaft
o Tarsometatarsal fracture-dislocation
Lisfrancs o Two types: homolateral and divergent
o Most common dislocation of the foot
March o Stress fracture of metatarsal neck
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Salter Harris Fractures
(Weissleder)
I Slipped Pure epiphyseal separation, fracture isolated to growth plate
Above Shearing or avulsion force that splits frowth plate before entering metaphyseal bone,
II
separating a small fragment the Thurston Holland or corner sign
Lower Fracture extends vertically through epiphysis and growth plate to hypertrophic zone and
III
then through growth plate itself
Together Vertically oriented splitting force producing a fracture that extends across epiphysis,
IV
growth plate and metaphysic; most frequently in distals portions of humerus and tibia
V Ruined Crushing or compressive injury
VI Injury to perichondrium can produce reactive bone formation external to growth plate
Associated with epiphyseal alterations in the absence of involvement of growth plate or
VII
metaphysic
Affects metaphyseal growth and remodeling mechanisms in immature skeleton, related
VIII
primarily to effects on blood supply
Injury to periosteum of diaphysis in rare circumstances may result in disruption of normal
IX
diaphyseal growth and remodeling
Swischuk
Nursemaids or o When arm is pulled, head of radius slips out of annular ligament and fails to return to
Pulled Elbow normal position after distracting forces stop
Toddlers Fracture o Originally, spiral fracture of tibia resulting from torque or twisting applied to lower leg
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