Eponymous fractures of Upper limb

EPONYMOUS FRACTURES (UPPER LIMB)

Mostly the medical students find it difficult to remember the fractures names especially for their exams, so here are some key features to remember the main eponymous fractures which would ease the problem.

UPPER LIMB FRACTURES

Bankart’s Fracture-

Bankart in 1938 described anterior tear of glenoid labrum as Bankart’s lesion. It’s the most common lesion associated with recurrent dislocation of shoulder which is a common complication of shoulder dislocation in young people and the corresponding bony fracture of the same area is called bankart’s fracture.

Hill-Sach’s Fracture-

It’s a fracture involving postero-lateral aspect of the head of humerus with depression in the anterior shoulder dislocation.

Remember – if there is anterior shoulder dislocation then postero-lateral shoulder affected; and when posterior dislocation is present then antero-medial shoulder affected.

Holstein-Lewis Fracture-

Humerus can be divided into 3 parts – upper (where radial nerve goes from axilla to humerus), middle (radial nerve travels in spinal groove) and lower part (where radial nerve pierces laterally the inter-muscular septum and comes anteriorly). So basically where the radial nerve more involved in the fracture of shaft of humerus? Its in the lower 3^rd portion of the humerus, as the nerve gets fixed here & so more prone to any injury. So Holstein-lewis fracture is a fracture of distal 3^rd of humerus, resulting in entrapment of radial nerve.

Just keep in mind that the lower 1/3^rd of radial nerve further divides into – Posterior interosseous(PI) nerve & Superficial radial(SR) nerve. This PI nerve is pure motor nerve which takes turn around the head of radius.

Remember that radial nerve is the most commonly nerve to be damaged in our body; moreover it has the best prognosis among all peripheral nerve injuries.

Galeazzi Fracture-

This fracture occurs due to blow to forearm. It’s main components are – fracture of lower part of radius, dislocation of distal radio-ulnar joint, damage to interosseous membrane & damage to triangular fibro-cartilage component at wrist joint.

Monteggia Fracture-

Its an ulnar fracture, hence the counter part of Galeazzi fracture. This fracture also involves dislocation of radial head (because around radial head, PI nerve travels, which is most commonly involved in injuries of Monteggia fracture). Bado classified this fracture based on the area where the radial head dislocates into –

1. Type I- if the radial head goes anteriorly

2. Type II- if the radial head goes posteriorly

3. Type III- if the radial head goes laterally

4. Type IV- when both radius and ulna fracture along with dislocation of radial head.

Hume Fracture-

Its an injury occurred in the kids. It’s a fracture of olecranon along with dislocation of radial head. It’s a variant of Monteggia fracture.

Essex-Lopresti Fracture-

It occurs due to fall from a height. It consists of 2 main components – elbow and wrist; connected by the damage involving interosseous membrane. This basically is a fracture of radial head with dislocation of distal radio-ulnar joint due to disruption of interosseous membrane, which explains the mechanism of the fracture.

Moore’s Fracture-

It’s a rare fracture of distal end of radius with dislocation of ulnar styloid and entrapment under annular ligament.

Nightstick Fracture-

Its an isolated fracture of ulna, due to direct blow without involving damage to any other component of forearm, elbow or the wrist. It’s an oblique or transverse fracture of ulna.

Greenstick Fracture-

Its an injury in which one of the cortex breaks and the other bends. This is a common pediatric injury which occurs due to bending forces after fall.

Boxer’s Fracture-

It involves the neck of the 5^th meta-carpal.

Injuries around the Wrist-

1. Colle’s Fracture –

Extra-articular fracture of distal end of radius. Its classically seen in osteoporetic females and caused by fall on outstretched hand, causing displacement posteriorly. “Dinner-fork” or “Bayonet” deformity seen. The most common complication is stiffness of fingers.

2. Smith’s Fracture –

It’s a counter fracture of Colle’s fracture, meaning that it is also an extra-articular fracture going anteriorly. “Garden-spade” deformity seen.

3. Barton’s Fracture –

It’s an intra-articular injury involving joint along with wrist dislocation. If the wrist goes anteriorly it’s “Volar” & if the wrist dislocates posteriorly it’s “Dorsal”.