DOI: 10.1148/rg.244045015
RadioGraphics 2004;24:1009-1027
© RSNA, 2004
Musculoskeletal Colloquialisms: How Did We Come Up with These Names?1
Patrick Lee, MD,
Tim B. Hunter, MD and
Mihra Taljanovic, MD
1 From the Department of Radiology, State University of New York, Downstate Medical Center, Brooklyn, NY (P.L.); and Department of Radiology, University of Arizona College of Medicine, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724-5067 (T.B.H., M.T.). Received February 11, 2004; revision requested March 10 and received March 30; accepted March 30. Address correspondence to T.B.H. (e-mail: tbh@3towers.com).
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Abstract
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Eponyms and colloquial terms are labels that provide two kinds of information: the pattern of a complex injury or pathologic problem and, in the case of an eponym, the name of an individual who has been closely identified with the pathologic problem. Such terms remind us that the medicine of today is not entirely the work of our contemporaries. The article illustrates many of the common colloquial terms applied to fractures and musculoskeletal injuries seen in everyday practice. Wherever possible, the illustrations and definitions are based on the original descriptions of the injuries.
© RSNA, 2004
Index Terms: Bones, injuries • Extremities, injuries • Fractures
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Introduction
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"Accuracy and conciseness are essential elements in medical communication. Accuracy is achieved through careful and painstaking use of medical nomenclature, which at times can be cumbersome. This difficulty has been overcome to some extent by the use of labels, tags, acronyms, and eponyms, which, when precisely defined and accurately used, convey a great deal of information very concisely" (1). Colloquial terms are labels that concisely provide information concerning the pattern of a complex injury or pathologic problem. "All labels, whether they are tags, acronyms, or eponyms, depend for their value on an accurate understanding of their meaning. Without this understanding, their use can be confusing, even dangerous" (1). Like eponyms, colloquial terms are valuable shorthand; they are abbreviated ways of conveying a good deal of specific information.
The Table classifies colloquial terms for musculoskeletal injuries by body site, and Figure 1 displays the relative locations for these injuries. In the remainder of the article, individual colloquial terms are defined and illustrated.
As we mentioned previously in our discussion of eponyms (1), eponyms and colloquial terms are often not used consistently or accurately. In some instances, there are reasonable differences of opinion concerning the proper descriptive term applied to a particular type of injury. We have tried to depict the injuries in a manner most consistent with their original description. Wherever possible, we tried to cite the original description of the colloquialism, but we were not able to find original sources in all cases. We have chosen to standardize the spelling of the terms by not using an apostrophe, similar to the convention of naming eponymic fractures, such as a Monteggia fracture, without an apostrophe (1). It is always best to describe soft-tissue and bone injuries by using standard anatomic and radiographic terminology. Avoid the use of an eponym or colloquial descriptive term unless you are certain of its precise definition, and never use a colloquial term—whether it is an abbreviation, tag, acronym, or eponym—as a stand-alone description for an injury or pathologic process.
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Colloquial Terms for Musculoskeletal Injuries
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Aviator Astragalus.—
The term aviator astragalus originated in World War I and is used today to describe a variety of talus injuries. It is one of the most poorly defined fracture colloquialisms and can be applied to almost any type of talar injury. It was originally used for injuries sustained in aviation accidents in which an aircraft struck the ground at high velocity and its rudder bar was driven upward into the pilot’s foot in front of the heel. Such accidents resulted in many types of astragalus (talus) injuries, including compression fractures of the talar neck and body and talar fracture dislocations. Such injuries were uncommon in the civilian population in those days before the widespread use of high-speed automobiles (2).
Backfire Fracture.—
See Chauffeur Fracture.
Baseball Finger.—
A baseball finger is also known as a dropped finger or mallet finger. It consists of a flexion deformity of the distal interphalangeal joint that results from an avulsion of the long extensor tendon at its insertion on the dorsal lip at the base of the distal phalanx (3). A small piece of bone is frequently avulsed from the dorsum of the phalanx along with the tendon, thereby allowing the distal phalanx to "drop" with respect to the rest of the finger (Fig 2).
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Figure 2. Baseball finger (dropped finger, mallet finger). Lateral view of a child’s index finger shows an avulsion fracture off the dorsal base of the distal phalanx (arrow). Because the deep extensor tendon attached to the distal phalanx at the osseous avulsion, the distal portion of the distal phalanx has no extensor tendon attachment and "drops" in a volar direction.
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Beat Knee.—
See Housemaid Knee.
Bending Fracture.—
See Bowing Fracture.
Boot Top Fracture.—
A boot top fracture consists of a break in the tibia shaft at the level of a boot top, an injury commonly sustained during skiing. The height of the ski boot determines the level of injury, and the fracture line may be transverse or spiral, depending on the mechanism of injury (4–6). These injuries are rare today because of the better release mechanisms in ski bindings.
Bowing Fracture.—
A bowing fracture (plastic deformity) occurs in children and is an incomplete fracture of one or both bones of the forearm or the lower leg. A bowing fracture can also occur in other long bones, such as the clavicle (Fig 3). One or both bones (radius and ulna or tibia and fibula) are bent in a smooth curve without obvious evidence of discontinuity (7–10). The mechanism of injury usually involves a fall onto a hyperextended, outstretched hand. The bowing deformity occurs in response to longitudinal stress applied to immature, plastic bones.
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Figure 3a. Bowing fracture. (a) Frontal chest radiograph of a young trauma patient shows a plastic deformity of the right clavicle (arrow). (b) Lateral forearm radiograph of a different young trauma patient shows a plastic bowing deformity of the radius (arrows).
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Figure 3b. Bowing fracture. (a) Frontal chest radiograph of a young trauma patient shows a plastic deformity of the right clavicle (arrow). (b) Lateral forearm radiograph of a different young trauma patient shows a plastic bowing deformity of the radius (arrows).
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Boxer Fracture.—
A boxer fracture is a transverse fracture of the metacarpal neck, with volar angulation of the distal fragment. A boxer fracture may occur in any of the metacarpals, but it is most commonly seen in the fifth metacarpal (Fig 4). The term is coined from one of the most common causes of the fracture: punching an object with a closed fist. It occurs commonly during fistfights and is often seen in patients who fell against a hard surface with their fist clenched in flexion (11,12). Some clinicians prefer to use the term brawler fracture because the better-trained boxer is less apt to acquire this injury.
Brawler Fracture.—
See Boxer Fracture.
Break-dancer Thumb.—
See Gamekeeper Thumb.
Bucket-handle Fracture.—
The bucket-handle fracture occurs when a large arc of bone is pulled from the margin of the metaphysis and projects into the oblique plane in a "bucket-handle" pattern (13,14) (Fig 5). The injury most commonly occurs in the long bones and is frequently seen in abused infants. It is a variant of the corner fracture.
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Figure 5a. Bucket-handle fracture. Radiographs of the right knee in a 10-month-old infant, who was a victim of child abuse and sustained multiple bone injuries, show a corner fracture at the distal end of the right femoral metaphysis (arrow in a), which later developed into a bucket-handle fracture (arrows in b) with further healing and further trauma. (Fig 5a and 5b courtesy of Rebecca L. Hulett, MD, Tucson, Ariz.)
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Figure 5b. Bucket-handle fracture. Radiographs of the right knee in a 10-month-old infant, who was a victim of child abuse and sustained multiple bone injuries, show a corner fracture at the distal end of the right femoral metaphysis (arrow in a), which later developed into a bucket-handle fracture (arrows in b) with further healing and further trauma. (Fig 5a and 5b courtesy of Rebecca L. Hulett, MD, Tucson, Ariz.)
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Buckle Fracture.—
See Torus Fracture.
Bumper Fracture.—
A bumper fracture occurs at the lateral side of the proximal portion of the tibia and is caused by direct impact of a car bumper or fender against the outer side of the leg, which was locked in extension. The level of the fracture depends on the height of the striking object. A bumper fracture is sometimes called a Cotton fracture of the knee (15) and is often accompanied by a butterfly fragment.
Burst Fracture.—
A burst fracture occurs in the vertebral body and results from axial compression loading, most frequently when the neck and lower back are in flexion (16,17). When vertical compression is applied, the vertebral end plates fracture and the nucleus of the disk is forced into the vertebral body, which "bursts" into multiple fragments (Fig 6). The normal posterior margin of the vertebral body is straight or concave. If it is convex, a burst fracture is probably present. There is usually widening of the interpediculate distance, and since at least two columns are involved, these fractures are considered unstable (17).
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Figure 6a. Burst fracture. (a) Lateral radiograph of the thoracic spine shows a complex fracture of T12 (arrows). (b) Computed tomographic (CT) scan better demonstrates the "burst" appearance of the vertebral fracture (arrows).
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Figure 6b. Burst fracture. (a) Lateral radiograph of the thoracic spine shows a complex fracture of T12 (arrows). (b) Computed tomographic (CT) scan better demonstrates the "burst" appearance of the vertebral fracture (arrows).
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Butterfly Fragment.—
A butterfly fragment is a fracture fragment that is located at the side of a comminuted fracture in between two main fractures and that resembles the wings of a butterfly (Fig 7) (18,19).
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Figure 7. Butterfly fragment. Frontal radiograph of the right femur shows a large butterfly-shaped bone fragment (arrow) next to a fracture in the proximal shaft. An intramedullary rod was placed to stabilize the fracture.
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Carpet-layer Knee.—
See Housemaid Knee.
Chauffeur Fracture.—
The chauffeur fracture is also known as a backfire fracture, a lorry driver fracture, or a Hutchinson fracture. It consists of an oblique fracture of the radial styloid process with extension into the radiocarpal joint (Fig 8) (20,21). The common names for this fracture arose in the era when hand cranking was needed to start motor vehicles. It is an outdated term, since motor vehicles are no longer started by hand cranking.
Chip Fracture.—
A chip fracture is a small avulsion fragment that is usually found at the capsular or ligamentous attachment site of a bone, such as the tip of the lateral malleolus or the ulnar styloid process. This injury is sometimes referred to as a corner fracture; however, the latter term is often used in cases of child abuse (see Corner Fracture).
Chisel Fracture.—
A chisel fracture is a linear, incomplete fracture of the head of the radius and appears similar to the line a chisel makes when it is pounded into a piece of wood (22). The fracture line extends distally from the middle of the articular surface (Fig 9).
Clay-shoveler Fracture.—
A clay-shoveler fracture represents a fracture of the spinous process of a lower cervical vertebra, usually C7 (Fig 10). It is often a fatigue fracture (23,24). It was first recognized in 1933 when previously unemployed men were given jobs digging drainage ditches in clay soil in southwestern Australia. The clay was tossed out of the ditches with long-handled shovels. As a worker tossed the shovel upward, the clay sometimes stuck to it, producing a sudden, unexpected opposite force on his neck and back muscles. Sometimes, there was an audible "crack," and a worker suffered an acute onset of pain because of avulsion of the tip of a lower cervical spinous process. Today, such fractures are often seen as incidental old injuries in patients undergoing cervical spine studies. They can also occur as acute injuries sustained in motor vehicle accidents and may result from sudden muscle contractions or even direct blows to the spine.
Compression Fracture.—
Compression fractures arise when a fragment of bone is forcibly driven into the adjacent fragment. These fractures most commonly occur in the bodies of vertebrae when the spine is hyperflexed. In this injury, the superior and inferior surfaces of the vertebral body are impacted on each other, producing a wedge-shaped deformity (25).
Corner Fracture.—
A corner fracture is a fracture at the metaphysis of a long bone that typically appears as a chip off the edge of the bone (13,14). It is frequently seen in cases of child abuse, but a somewhat similar injury may also occur with rickets, scurvy, Menkes syndrome, and severe osteogenesis imperfecta. When a larger arc of bone is involved, it is called a bucket-handle fracture. Sometimes, the term corner fracture is used synonymously with that of a chip fracture; however, since these two terms have inconsistent definitions, it is best to avoid their use altogether.
Crush Fracture.—
See Compression Fracture.
Dancer Fracture.—
A dancer fracture is usually considered to be an avulsion fracture of the base of the fifth metatarsal when traction is exerted from the peroneus brevis tendon (Fig 11). The foot is forcefully inverted and plantar flexed when the injury occurs. Pain is most pronounced when pressure is applied to the toes or the inner side of the foot, and swelling is localized over the fracture. This fracture is similar to the Jones fracture, which occurs at the base of the fifth metatarsal but distal to the metatarsal tuberosity. The latter fracture was described by Robert Jones in 1902 after he injured himself dancing (26). Unfortunately, the term dancer fracture may sometimes be applied to a Jones fracture, since Jones sustained this fracture while dancing. Also, many persons apply the term Jones fracture to an avulsion fracture at the base of the fifth metatarsal. For these reasons, it is best to avoid the use of either term. These terms should never be used as sole descriptor of a fracture involving the fifth metatarsal.
Dashboard Fracture.—
The dashboard fracture is a break in the posterior rim of the acetabulum. The fracture results when a seated automobile passenger is thrown forward in an accident and strikes the dashboard with his or her knee, forcing the head of the femur into or through the posterior rim of the acetabulum and often producing a posterior hip dislocation (Fig 12). These fractures are also associated with patellar fractures and posterior cruciate ligament rupture (27).
Don Juan Fracture.—
See Lovers Fracture.
Dropped Finger.—
See Baseball Finger.
Fatigue Fracture.—
A fatigue fracture results from repeated trauma to an otherwise normal, healthy bone. The repeated stress to the bone promotes bone resorption, causing gradual dissolution at the site of strain that can later result in a complete fracture. A fatigue fracture most commonly occurs in the metatarsals (see March Fracture), but it can also occur in the pelvis, calcaneus, tibia, fibula, and femoral neck and shaft (25).
Fender Fracture.—
See Bumper Fracture.
Gamekeeper Thumb.—
Gamekeeper thumb consists of an acute or chronic injury to the ulnar collateral ligament of the thumb metacarpophalangeal joint. It was first observed in Scottish gamekeepers, who suffered repeated stress injury to the ulnar collateral ligament of their thumb metacarpophalangeal joints because they used their thumbs as a focal point to snap the neck of a rabbit. As reported by Campbell, "... the condition is so common among gamekeepers as to constitute an occupational characteristic... the condition is so characteristic that a recent patient who denied being a gamekeeper later admitted an extensive interest in the poaching of rabbits" (Fig 13) (28). The injury can also be seen in skiers (skier pole injury, skier thumb) or in break-dancers (break-dancer thumb) (29–33). Along with injury to the ulnar collateral ligament, a small chip of bone can be avulsed off the proximal phalanx of the thumb. A related injury is the Stener lesion, in which there is a complete rupture of the ulnar collateral ligament, with the ligament becoming folded over and pointing proximally (34).
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Figure 13a. Gamekeeper thumb (break-dancer thumb, skier thumb, skier pole injury). (a) Frontal radiograph shows a fracture (arrow) at the ulnar corner of the proximal phalanx of the thumb. Most gamekeeper injuries involve tears of the ulnar collateral ligament and do not have an associated fracture. (b) Sonogram of a different patient shows a complete tear (between the cursors) of the ulnar collateral ligament of the thumb metacarpophalangeal joint.
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Figure 13b. Gamekeeper thumb (break-dancer thumb, skier thumb, skier pole injury). (a) Frontal radiograph shows a fracture (arrow) at the ulnar corner of the proximal phalanx of the thumb. Most gamekeeper injuries involve tears of the ulnar collateral ligament and do not have an associated fracture. (b) Sonogram of a different patient shows a complete tear (between the cursors) of the ulnar collateral ligament of the thumb metacarpophalangeal joint.
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Golfer Wrist.—
Golfer wrist consists of a stress fracture of the hook of the hamate bone of the wrist (Fig 14) (35). It usually affects the nondominant hand and may be quite difficult to diagnose on plain radiographs. Because the nondominant hand is the hand closest to the butt of the golf club, it receives greater stress than the dominant hand and thus is more frequently affected. The injury can also be seen in patients who participate in sports associated with repeated swinging motions such as tennis and baseball.
Greenstick Fracture.—
A greenstick fracture is an incomplete fracture of a long bone (usually in the forearm) and commonly occurs in young children. Typically, the side opposite the bending force fractures completely, whereas the side under the force remains intact (Fig 15). As the name implies, the fracture resembles the break that results when a supple green branch of a tree is bent and breaks incompletely. A greenstick fracture results from a bending force applied perpendicular to the shaft of a long bone, whereas a buckle fracture or torus fracture results when a force is applied along the axis of the shaft of a long bone (36).
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Figure 15a. Greenstick fracture. Frontal (a) and lateral (b) images of a 5-year-old child who fell off a bike show incomplete fractures of the radius and ulna. The cortex is fully broken (black arrows) on one side of the bones and intact on the other side (white arrows).
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Figure 15b. Greenstick fracture. Frontal (a) and lateral (b) images of a 5-year-old child who fell off a bike show incomplete fractures of the radius and ulna. The cortex is fully broken (black arrows) on one side of the bones and intact on the other side (white arrows).
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Gymnast Wrist.—
Gymnast wrist is a compression injury to the distal radial growth plate caused by repetitive stress to the wrists of a young athlete whose bones are still growing (37,38). It commonly occurs in young gymnasts because their wrists are subjected to excessive physical loading while their bones are still growing. Gymnast wrist is thought to be a Salter-Harris type I injury of the growth plate or a stress fracture of the epiphysis. Its radiographic appearance "... consists of bilateral, asymmetrical widening and irregularity of the distal radial growth plates with an ill-defined cystic appearance, sclerosis and flaring of the metaphyses... " (37).
Hangman Fracture.—
A hangman fracture consists of bilateral fractures through the lamina or pedicles of the axis (C2), usually associated with subluxation (anterolisthesis) of the body of the axis on C3 (Fig 16). These fractures were first described through postmortem examination of persons executed by hanging (39–41). A good executioner positioned the noose so that the victim would die of a sudden, massive, high cervical spine injury instead of slowly asphyxiating due to a crushed larynx or trachea.
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Figure 16. Hangman fracture. Lateral view of the cervical spine in a motor vehicle accident patient shows bilateral fractures (arrow) through the lamina of the axis (C2) associated with subluxation of the body of the axis on C3.
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Hickory Stick Fracture.—
See Greenstick Fracture.
Housemaid Knee.—
Housemaid knee consists of inflammation in the prepatellar bursa (prepatellar bursitis) that usually arises from minor repetitive injury such as working on one’s hands and knees (Fig 17). Wrestler knee, beat knee, and carpet-layer knee are other synonymous terms that relate to occupations involving chronic irritation from excessive kneeling (42–44). A related but less common injury that can also occur with excessive kneeling is infrapatellar bursitis, also known as preacher knee.
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Figure 17a. Housemaid knee. (a) Sagittal T1-weighted magnetic resonance (MR) image of the knee shows fluid (arrow) in the prepatellar bursa. (b) Axial fat-saturated intermediate-weighted MR image also shows the fluid (*) in the prepatellar bursa.
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Figure 17b. Housemaid knee. (a) Sagittal T1-weighted magnetic resonance (MR) image of the knee shows fluid (arrow) in the prepatellar bursa. (b) Axial fat-saturated intermediate-weighted MR image also shows the fluid (*) in the prepatellar bursa.
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Impaction Fracture.—
An impaction fracture is a break in bone that occurs when a fragment of one bone is driven into an apposing fragment. It most commonly occurs in cancellous bone because its spongy composition most easily permits the compression necessary to effect impaction (25). The two forms of impaction include depression and compression.
Insufficiency Fracture.—
Insufficiency fractures occur when a normal stress breaks a bone that is abnormal and deficient of elasticity. These fractures should be distinguished from a fatigue fracture, which is a fracture that occurs when excessive stress is applied to normal bone. Some clinical entities that reduce elastic resistance of bone and thus predispose it to insufficiency fractures include bone diseases (osteogenesis imperfecta, osteitis deformans), metabolic disorders (osteoporosis, hyperparathyroidism, rickets), and inflammatory conditions (osteomyelitis, rheumatoid arthritis) (45).
Jersey Finger.—
Jersey finger is an avulsion of the flexor profundus tendon insertion at the ulnar aspect of the base of the distal phalanx of a finger. The ring finger is most frequently affected. Jersey finger is a relatively common injury among athletes, most frequently seen in American football players (46). Classically, the injury occurs as the player grabs a jersey during a tackle. Following this trauma, the distal phalanx cannot be flexed and the tendon can often be felt in the volar aspect of the finger or palm.
Jumper Fracture.—
A jumper fracture involves a transverse fracture of the upper sacrum (47). It is an injury that occurs from falls from great height, most commonly in attempts of suicide. Often, such fractures are not recognized in the acute stage because of the other associated injuries that occur with a fall.
Jumper Knee.—
Jumper knee represents proximal patellar tendonosis that occurs with repetitive overloading of the extensor mechanism of the knee (Fig 18) (48). Microtears to the patellar tendon continue unless the aggravating activity is stopped for a period of time. The injury occurs in sports that require explosive jumping movements, such as basketball, volleyball, and soccer.
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Figure 18a. Jumper knee. Sagittal T1-weighted (a) and fat-saturated intermediate-weighted (b) MR images of the knee show proximal patellar tendon changes (arrow), consistent with microtears and edema caused by repetitive overloading of the knee during extensive sports activities.
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Figure 18b. Jumper knee. Sagittal T1-weighted (a) and fat-saturated intermediate-weighted (b) MR images of the knee show proximal patellar tendon changes (arrow), consistent with microtears and edema caused by repetitive overloading of the knee during extensive sports activities.
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Little League Elbow.—
Little League elbow is applied to a group of clinical disorders resulting from elbow overuse in children. One form of Little League elbow is known as Panners disease, which consists of rarefaction and fragmentation of the capitellum in children that occur with repetitive motion of the arm (Fig 19). Radiographs show an irregular lucent area in the capitellum and occasionally loose bodies within the joint. The continued valgus stress during the acceleration phase of pitching compresses the radial head on the capitellum and distracts the medial epicondyle apophysis (49). In some cases, this situation can lead to inflammation or avulsion of the medial epicondyle.
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Figure 19. Little League elbow. Frontal and lateral views of the elbow in an active Little League pitcher shows rarefaction and fragmentation of the capitellum (arrow) from repetitive overuse of the elbow.
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Lorry Driver Fracture.—
See Chauffeur Fracture.
Lovers Fracture.—
Lovers fracture represents an intraarticular calcaneal fracture caused by jumping or falling from great heights. It is the type of fracture that a suitor sustains while jumping from an upper floor window while trying to escape from the wrath of a lover’s spouse. It may also be associated with a compression fracture of the spine (50).
Mallet Finger.—
See Baseball Finger.
March Fracture.—
A march fracture is a fatigue fracture of one of the metatarsals (Fig 20). These fractures are most commonly found in military recruits who frequently jump and march in their vigorous training (51–53). A Prussian military physician first described the condition in 19th century soldiers with edematous and painful feet (52). These symptoms were later shown to be due to a fracture of the metatarsal shaft (51,53).
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Figure 20a. March fracture (fatigue fracture). (a, b) Frontal radiographs of the right foot in a college gymnast show the early (a) and late (b) radiographic findings of a second metatarsal fatigue fracture (arrow). The fracture completely healed with rest. (c, d) Coronal T2-weighted fat-saturated (c) and sagittal T1-weighted (d) MR images obtained at the same time as a show marked mass effect (arrows) around the second metatarsal. This finding could have been misinterpreted as a neoplasm or infectious process without the radiographs and proper patient history.
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Figure 20b. March fracture (fatigue fracture). (a, b) Frontal radiographs of the right foot in a college gymnast show the early (a) and late (b) radiographic findings of a second metatarsal fatigue fracture (arrow). The fracture completely healed with rest. (c, d) Coronal T2-weighted fat-saturated (c) and sagittal T1-weighted (d) MR images obtained at the same time as a show marked mass effect (arrows) around the second metatarsal. This finding could have been misinterpreted as a neoplasm or infectious process without the radiographs and proper patient history.
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Figure 20c. March fracture (fatigue fracture). (a, b) Frontal radiographs of the right foot in a college gymnast show the early (a) and late (b) radiographic findings of a second metatarsal fatigue fracture (arrow). The fracture completely healed with rest. (c, d) Coronal T2-weighted fat-saturated (c) and sagittal T1-weighted (d) MR images obtained at the same time as a show marked mass effect (arrows) around the second metatarsal. This finding could have been misinterpreted as a neoplasm or infectious process without the radiographs and proper patient history.
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Figure 20d. March fracture (fatigue fracture). (a, b) Frontal radiographs of the right foot in a college gymnast show the early (a) and late (b) radiographic findings of a second metatarsal fatigue fracture (arrow). The fracture completely healed with rest. (c, d) Coronal T2-weighted fat-saturated (c) and sagittal T1-weighted (d) MR images obtained at the same time as a show marked mass effect (arrows) around the second metatarsal. This finding could have been misinterpreted as a neoplasm or infectious process without the radiographs and proper patient history.
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Nightstick Fracture.—
A nightstick fracture is an isolated fracture of the ulna, usually in itsmiddle third (Fig 21). It is not associated with a radius fracture or a dislocation at the proximal or distal radioulnar joint. The fracture usually results from a direct blow to the ulna, such as from a policeman’s baton or nightstick (54). The term nightstick fracture has supplanted the older phrase parry fracture coined by Bohler (55).
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Figure 21. Nightstick fracture. Frontal view of the forearm in a patient injured in a motor vehicle accident shows a minimally displaced fracture (arrows) of the distal ulnar shaft.
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Nursemaid Elbow.—
A nursemaid elbow or pulled elbow has been known since antiquity (56). It occurs when an adult or older, larger child (the nursemaid) jerks a young child upright or forward by a sudden tug of the hand. The injury may happen when an adult pulls the child in a different direction than the child was heading or when the child, who was running beside the adult, stumbles. The injury typically occurs in children younger than 5 years, and it may produce a painful paralysis of the arm, because there is subluxation of the radial head out of the annular ligament (56). There are no acute bone changes, but the long axis of the radius will not intersect the capitellum on standard views of the elbow. Sometimes, the subluxation spontaneously resolves or resolves when the patient’s arm is being positioned for radiography (Fig 22).
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Figure 22a. Nursemaid elbow. (a, b) Frontal (a) and lateral (b) radiographs of the right elbow in a young child whose arm was jerked by an older sibling demonstrates dislocation of the radius. A line through the central axis of the radial shaft does not intersect the capitellum. The radial head has not yet ossified. (c) Frontal view obtained after reduction of the dislocation shows that a line through the central axis of the radial shaft now intersects the capitellum.
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Figure 22b. Nursemaid elbow. (a, b) Frontal (a) and lateral (b) radiographs of the right elbow in a young child whose arm was jerked by an older sibling demonstrates dislocation of the radius. A line through the central axis of the radial shaft does not intersect the capitellum. The radial head has not yet ossified. (c) Frontal view obtained after reduction of the dislocation shows that a line through the central axis of the radial shaft now intersects the capitellum.
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Figure 22c. Nursemaid elbow. (a, b) Frontal (a) and lateral (b) radiographs of the right elbow in a young child whose arm was jerked by an older sibling demonstrates dislocation of the radius. A line through the central axis of the radial shaft does not intersect the capitellum. The radial head has not yet ossified. (c) Frontal view obtained after reduction of the dislocation shows that a line through the central axis of the radial shaft now intersects the capitellum.
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Panners Disease.—
See Little League Elbow.
Parry Fracture.—
See Nightstick Fracture.
Preacher Knee.—
Preacher knee is similar to housemaid knee except the inflamed bursa involved is the infrapatellar superficial bursa. Its prevalence has been decreased by the introduction of padded kneelers in churches and the use of kneepads for workers, such as plumbers and carpet layers, who spend a lot of time working on their knees. Often, the inflammation of the infrapatellar bursa is accompanied by a prepatellar bursitis, hence housemaid knee (57).
Pulled Elbow.—
See Nursemaid Elbow.
Runner Fracture.—
A runner fracture is a stress fracture of the fibula that usually occurs in the distal fibula 2 inches or more above the tip of the lateral malleolus (58,59). Long-distance endurance runners are prone to fibular stress injuries, especially if they train on hard surfaces. This injury is being seen with increasing frequency as runners are striving to achieve greater running distances.
Seat Belt Fracture.—
A seat belt fracture is also commonly known as a Chance fracture and consists of a transverse fracture through a vertebral body or disk space and the neural arch (Fig 23) (1). It occurs at the thoracolumbar junction and is usually associated with a motor vehicle accident in which the injured passenger was wearing a seat belt.
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Figure 23a. Seat belt fracture (Chance fracture). (a) Lateral radiograph of the thoracolumbar junction in a trauma patient shows a mild compression deformity in L1 and a fracture (arrows) that spans all three columns of the vertebra. (b) Sagittal reformatted image from a CT study shows the same findings (arrows) as observed radiographically.
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Figure 23b. Seat belt fracture (Chance fracture). (a) Lateral radiograph of the thoracolumbar junction in a trauma patient shows a mild compression deformity in L1 and a fracture (arrows) that spans all three columns of the vertebra. (b) Sagittal reformatted image from a CT study shows the same findings (arrows) as observed radiographically.
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Skier Pole Injury, Skier Thumb.—
"Acute rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb is often sustained in downhill skiing accident and is hence called ‘skier’s thumb’ " (30). It is similar to gamekeeper thumb and the Stener lesion. Skier thumb is a very common sports injury, being second only to medial collateral ligament damage in skiing-related injuries (30).
Snowboarder Fracture.—
A snowboarder fracture consists of a fracture of the lateral process of the talus that occurs when a snowboarder jumps and lands violently with the soles of the feet turned inward (60,61). The injury is difficult to identify on plain radiographs and frequently requires CT to delineate the fracture line. Referring physicians must have a high degree of suspicion as this injury can mimic an ankle sprain.
Stener Lesion.—
A Stener lesion represents a complete rupture of the ulnar collateral ligament of the thumb interphalangeal joint, usually distally, with the ulnar collateral ligament folded back on itself proximally. Stener (34), who originally reported this condition in 1962, described the findings in one patient as "the ruptured end of the ligament has passed the proximal edge of the adductor aponeurosis so that the aponeurosis has become interposed between this end and the site of its attachment to the phalanx." The term Stener lesion is more correctly called an eponym rather than a colloquialism.
Stress Fracture.—
See Fatigue Fracture.
Teardrop Fracture.—
The term teardrop fracture is usually reserved for an acute flexion fracture dislocation of the cervical spine with a teardrop fracture fragment hanging off the anterior inferior corner of the injured vertebra (62). The body of the vertebra is compressed anteriorly and sometimes bursts. As part of the severe flexion injury, there is ligamentous disruption and the posterior inferior portion of the vertebra may be transiently displaced posteriorly, causing spinal cord injury. This injury often has a benign radiographic appearance that belies the neurologic insult the patient has received. MR imaging is the modality of choice to evaluate a possible spinal cord injury.
Tennis Elbow.—
Tennis elbow consists of tendonosis of the extensor tendon over the lateral epicondyle of the elbow (Fig 24). It is an overuse injury that occurs with repeated minor trauma, such as that sustained in backstrokes during a tennis match or by using a screwdriver for long periods of time (63). It may also be caused by fencing, boxing, and hammering.
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Figure 24a. Tennis elbow. (a) Coronal T2-weighted fat-saturated MR image of the right elbow in an active tennis player shows inflammation and at least partial rupture of the common extensor tendon (arrow). (b) Sonogram shows a partial tear and degeneration with edema (arrow) at the attachment of the common extensor tendon at the lateral epicondyle.
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Figure 24b. Tennis elbow. (a) Coronal T2-weighted fat-saturated MR image of the right elbow in an active tennis player shows inflammation and at least partial rupture of the common extensor tendon (arrow). (b) Sonogram shows a partial tear and degeneration with edema (arrow) at the attachment of the common extensor tendon at the lateral epicondyle.
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Toddler Fracture.—
A toddler fracture is a spiral hairline fracture in the distal shaft of the tibia that is seen in young children (Fig 25) (64). It occurs when a child is running, or steps on something, and then loses his or her footing. The abrupt twisting of the tibia produces a fracture in a spiral pattern. As with other breaks in young children, these fractures tend to be incomplete or minimally displaced, and therefore sometimes difficult to recognize clinically and radiographically.
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Figure 25. Toddler fracture. Frontal radiograph of a young ambulatory infant, who fell and twisted his right lower leg, shows a spiral fracture (arrows) in the distal portion of the tibia.
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Torus Fracture.—
A torus fracture is an incomplete fracture of the shaft of a long bone that is characterized by buckling or bulging of the cortex (Fig 26a) (25). It is usually seen in children, frequently in the distal radius diaphysis or metaphy-sis. The term is derived from the architectural word torus used to describe the convex projecting molding used at the base of a column (Fig 26b).
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Figure 26a. Torus fracture. (a) Frontal radiograph of the wrist in a young child, who fell on her outstretched hand, shows buckling (arrows) of the metaphyseal cortex. (b) Idealized drawing of a classic Greek column illustrates the resemblance of the column torus to the fracture in a.
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Figure 26b. Torus fracture. (a) Frontal radiograph of the wrist in a young child, who fell on her outstretched hand, shows buckling (arrows) of the metaphyseal cortex. (b) Idealized drawing of a classic Greek column illustrates the resemblance of the column torus to the fracture in a.
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Turf Toe.—
Turf toe describes a sprain of the plantar capsule-ligament of the great toe metatarsophalangeal joint (65). The injury most commonly affects football athletes who play on artificial turf with "turf shoes." When the athlete attempts to stop abruptly or is tackled, the cleats grab the turf. As the great toe slides over the insole and hits the inside of the shoe, the applied force drives the metatarsophalangeal joint into hyperextension, producing the sprain.
Wagon Wheel Fracture.—
The wagon wheel fracture represents a separation of the distal femoral epiphysis from the main portion of the femur in a child (Fig 27). It is an old term derived when wagons were common. Children injured their femur when they attempted to hitch a ride on a wagon and their legs were caught in the spokes of a wagon wheel (66). The trapped foot in the turning wagon wheel causes twisting and hyperextension of the knee, resulting in this injury.
Wrestler Knee.—
See Housemaid Knee.
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Acknowledgments
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The authors are grateful for the encouragement and scholarly help given to them by the late Leonard F. Peltier, MD, PhD, who was a wonderful gentleman and a superb physician and scholar.
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References
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- Hunter TB, Peltier L, Lund P. Fracture eponyms: who are those guys? RadioGraphics 2000; 20:819-836.[Free Full Text]
- Anderson HC. The medical and surgical aspects of aviation New York, NY: Oxford University Press, 1919; 183-184.
- Stark HH, Bayes JH, Wilson JN. Mallet finger. J Bone Joint Surg Am 1962; 44:1061-1068.[Abstract/Free Full Text]
- Dubravcik P, Burke DL. Ski fractures above and below the boot top. Can J Surg 1979; 22:343-346.[Medline]
- Hoflin F, van der Linden W. Boot top fractures. Orthop Clin North Am 1976; 7:205-213.[Medline]
- van der Linden W. The skiers’ boot top fracture: rising incidence, characteristics, treatment. Acta Orthop Scand 1969; 40:797-806.[Medline]
- Dupuytren G. Sur quequeles cas particuliers de fractures ou de courbures des os survenus a des enfens. Bull Faculte Med Paris 1811; 2:152-160.
- Barton JR. Remarks on certain injuries of the bones in children. Am Med Recorder 1821; 4:9-20.
- Crowe JE, Swischuk LE. Acute bowing fractures of the forearm in children: a frequently missed injury. AJR Am J Roentgenol 1977; 128:981-984.[Abstract]
- Borden S. Traumatic bowing of the forearm in children. J Bone Joint Surg Am 1974; 56:611-616.[Abstract/Free Full Text]
- Jahss SA. Fractures of the metacarpal: a new method of reduction and immobilization. J Bone Joint Surg Am 1938; 20:178-186.[Abstract/Free Full Text]
- Rider DL. Fractures of the metacarpals, metatarsals, and phalanges. Am J Surg 1937; 38:549-559.[CrossRef]
- Caffey J. Some traumatic lesions in growing bones other than fractures and dislocations: clinical and radiological features. Br J Radiol 1957; 30:225-238.
- Kleinman PK, Marks SC, Blackbourne B. The metaphyseal lesion in abused infants: a radiologic-histopathologic study. AJR Am J Roentgenol 1986; 146:895-905.[Abstract/Free Full Text]
- Cotton FJ. Fender fractures of the tibia at the knee. N Engl J Med 1929; 281:989-995.
- Holdsworth F. Fractures, dislocations, and fracture-dislocation of the spine. J Bone Joint Surg Am 1970; 52:1534-1551.[Abstract/Free Full Text]
- Atlas SW, Regenbogen V, Rogers LF, Kim KS. The radiographic characterization of burst fractures of the spine. AJR Am J Roentgenol 1986; 147:575-582.[Abstract/Free Full Text]
- Johner R, Wruhs O. Classification of tibial shaft fractures and correlation with results after rigid internal fixation. Clin Orthop 1983; 178:7-25.
- Muller ME, Nazarian S, Koch P, Schatzker J. The comprehensive classification of fractures of long bones Berlin, Germany: Springer-Verlag, 1990.
- Hutchinson J. Original Lectures. Notes on some of the more rare forms of fractures and dislocations. Medical Times Gazette 1866; June 30:683-684.
- Edwards HC. The mechanism and treatment of backfire fracture. J Bone Joint Surg Am 1926; 4:701-717.
- Klems H, Kolbel R. Bilateral chisel fracture of the radius head. Monatsschr Unfallheilkd Versicher Versorg Verkehrsmed 1971; 74:568-569.[Medline]
- McKellar Hall RD. Clay-shoveler’s fracture. J Bone Joint Surg Am 1940; 22:63-75.[Free Full Text]
- Cancelmo JJ, Jr. Clay-shoveler’s fracture: a helpful diagnostic sign. Am J Roentgenol Radium Ther Nucl Med 1972; 115:540-543.[Medline]
- Schultz RJ, Schumann GB. The language of fractures. 2nd ed Baltimore, Md: Williams & Wilkins, 1990.
- Jones R. Fractures of the base of the fifth metatarsal bone by indirect violence. Ann Surg 1902; 35:69
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Abstract
Introduction
