EPONYMOUS FRACTURES

EPONYMOUS FRACTURES
OF THE LOWER LIMB

Overview

 Femur
 Tibia/tibula
 Ankle
 Foot

Pipkin fracture

 Classification for
femoral head
fractures

 Uncommon
 Associated with hip

dislocations

Classification

 type I: fracture inferior to
the fovea capitis, a small
fracture not involving the
weightbearing surface

 type II: fracture
extending superior to the
fovea capitis, a large
fracture involving the
weightbearing surface

Classification

 type III: type I or II
fracture with a fracture of
the femoral neck, has an
increased risk
of avascular necrosis

 type IV: type I or II
fracture with a fracture of
the acetabular wall,
usually the posterior wall

Segond fracture

 an avulsion fracture of the knee that
involves the lateral aspect of the
tibial plateau and is very frequently
associated with disruption of the
anterior cruciate ligament (ACL). On
the frontal knee radiograph, it may
be referred to as the lateral capsular
sign.

 occurs as a result of internal rotation
and varus stress

Toddler’s fracture

 minimally or undisplaced spiral
fracture, of the distal third tibia,
typically encountered in toddlers

 should NOT be mistaken as non-
accidental injury (NAI)

 believed to be the result of new
stresses placed on the bone due
to recent and increasing
ambulation

Maisonneuve fracture

 spiral fracture of the
upper third of the fibula
associated with a tear of
the distal tibiofibular
syndesmosis and the
interosseous membrane

 associated with fracture
of the medial malleolus or
rupture of the deep
deltoid ligament



Gosselin Fracture

 V-shaped fracture of the distal
tibia that extends into the tibial
plafond and divides the plafond
into anterior and posterior
fragments

 Distal tibia fractures that involve
the articular surface or tibial
plafond are also known as “Pilon
fractures.”

Tillaux fracture

 An avulsion fracture of the
anterolateral tubercle of the
distal tibia caused by a pull of
the anteroinferior tibiofibular
ligament during external
rotation.

 Vertical fracture through the
distal tibial epiphysis (SH III)
with a horizontal extension
through the lateral aspect of
the physis

Tillaux fracture

 Occurs in the adolescents, as
the ligament is usually
stronger than the
anterolateral epiphysis, which
is open and susceptible to
injury

 The distal tibial epiphysis
fuses from medial to lateral

Shepherd fracture

 fracture of the lateral tubercle of the posterior process of the
talus

 typically resulting from ankle inversion, forced plantar flexion,
or direct compression injury in which the posterior talofibular
ligament avulses the tubercle

 best seen on lateral radiographs

Shepherd fracture

 may be mistaken for
an os trigonum

 os trigonum is
rounded or oval with
smooth corticated
edges while a
fracture is usually
sharply marginated,
non-corticated and
irregular

Cedell fracture

 avulsion fracture of the medial
tubercle

 due to excessive forces placed
on the posterior talotibial
ligament via sudden pronation-
dorsiflexion

Lisfranc injury

 Lisfranc joint is the
tarsometatarsal joint
complex which joins the
forefoot and midfoot

 The Lisfranc ligament is a
strong band attaching the
medial cuneiform to the
2nd metatarsal base on
the plantar aspect of the
foot

Lisfranc injury

 Malalignment of the
second
tarsometatarsal joint

 Diastasis >2 mm
between the first and
second metatarsal
bases



March fracture

 A type of stress fracture
 Classically referred to

fracture at the 2nd
metatarsal
 Named due to high
prevalence in soldiers who
partake in lengthy
marching as part of
training

March fracture

 Occult, suspected fractures may
not be visible on plain
radiographs

 Bone scan is sensitive but not
specific

 MRI on the other hand is both
sensitive and specific

Jones fracture

 a transverse fracture at the
metaphyseal/diaphyseal junction
without distal extension beyond
the fourth to fifth
intermetatarsal articulation

 should be differentiated from the
“Dancer’s fracture,” (or pseudo-
Jones fracture), which is an
avulsion fracture of the fifth
metatarsal base, proximal to the
more diaphyseal Jones fracture

Dancer’s fracture

 A twisting injury to
the ankle and foot
may cause an
avulsion fracture of
the base of the 5th
metatarsal

Fracture or not?

Quiz

1. What is the centering point for
an AP radiograph of the foot?

 centre of the lateral cuneiform
 base of the 3rd metatarsal
 base of metatarsals or midfoot
 midshaft of the 3rd metatarsal

2. What is the mechanism behind this
injury?

 external rotation and varus
stress

 external rotation and valgus
stress

 internal rotation and varus
stress

 internal rotation and valgus
stress

3. What is the name given to this
linear lucency?

 5th metatarsal apophysis
 Dancer's fracture
 Jones fracture
 Iselin disease

4. Which of these fractures involve the talus?

 Cedell and Shepherd
 Maisonneuve and Pipkin
 Jones and Gosselin
 Bosworth and Cotton

5. What type of fracture
is this?

 Pipkin I
 Pipkin II
 Pipkin III
 Pipkin IV

6. What are the routine views for a foot series?

 PA and lateral
 AP and lateral
 AP and lateral oblique
 AP and medial oblique

7. What is the name of the
bony fragment posterior to
the talus?

 Os trigonum
 Os peroneum
 Shepherd fracture
 Os naviculare

8. Which is NOT true regarding collimation of an AP view of the
femur?

 immediately superior to AIIS
 inferior to the proximal tibia/fibula
 laterally to include skin folds
 superior to the ASIS

References

 What’s in a name? Lower extremity fracture eponyms (Part 2)
https://dx.doi.org/10.1186%2Fs12245-015-0076-1

 Radiopaedia
 Orthobullets