CCH: Orthopedic terminology vol1

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A MANUAL OF ORTHOPAEDIC TERMINOLOGY,

EIGHTH EDITION ISBN: 978-0-323-22158-0

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Notices

Knowledge and best practice in this field are constantly changing. As new research and experience broaden

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Library of Congress Cataloging-in-Publication Data

Nelson, Fred R. T., 1941- author.

A manual of orthopaedic terminology / Fred R.T. Nelson, Carolyn Taliaferro Blauvelt. -- Eighth edition.

p. ; cm.

Includes index.

ISBN 978-0-323-22158-0 (paperback : alk. paper)

I. Blauvelt, Carolyn Taliaferro, 1933- author. II. Title.

[DNLM: 1. Orthopedics--Terminology--English. WE 15]

RD723

616.7001ʹ4--dc23

2014014681

Content Strategist: Delores Meloni

Content Development Specialist: Margaret Nelson

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Printed in the United States

Last digit is the print number: 9 8 7 6 5 4 3 2 1

v

Medical terminology is by necessity complex. Understanding

the “jargon” of medicine takes extensive years

of education and enculturation. Orthopaedic terminology

is perhaps the most difficult of all because of the

breadth of disease and injury that affects the musculoskeletal

system. Terms related to anatomy, pathology,

physiology, genetic injury descriptors, and syndromes

require an intimate knowledge of the broad field of orthopaedics.

Individuals other than those well versed in

the terminology need resources to answer their inquiries

and investigations. Practitioners in need of a lexicon

include researchers, physicians in fields other than

orthopaedics, the legal profession, and the universe of

patients.

For 35 years, Nelson and Blauvelt have provided

a wonderful resource to assist this population of

consumers of orthopaedic information. They have periodically

refined the manual to keep it up to date and

comprehensive within the evolving universe of musculoskeletal

medicine. This resource can guide individuals

as they perform literature reviews, systematic reviews

of that literature, meta-analyses, and other clinical

investigations in the field of orthopaedics. This tool is

straight-forward, easy to read, and comprehensive. It

will continue to serve as the go-to reference for individuals

needing to access orthopaedic information to

serve their individual audiences.

Marc F. Swiontkowski, MD

Professor, Department of Orthopaedic Surgery

University of Minnesota

CEO, TRIA Orthopaedic Center

Foreword

vii

This manual was first published more than 35 years ago

to encompass the vast terminology unique to orthopaedic

surgery and its related allied health fields, (i.e., radiology,

prosthetics, orthotics, and physical and occupational

therapy). Scientific discoveries and technological

advances led to new and updated editions and, during

that time, the publishing industry merged and moved

to the paperless electronic age of publishing.

The manual has continued to provide a reference

source for medical students, interns, residents, orthopaedic

nurses and technicians, and transcriptionists

and office managers in hospital and doctors offices.

Newcomers to orthopaedics, such as sales representatives

for pharmaceutical and surgical devices, medical

publishers, insurance adjustors, and attorneys, have also

appreciated this reference source for better clarification

of orthopaedic terminology. The format of this manual

enables the layperson without a strong musculoskeletal

background to understand why terms are not in A-Z

order, but rather are placed in their proper context to

facilitate understanding of both the words and their

associations.

New procedures and devices have been developed

that are rapidly replacing those found in former editions.

However, some devices named have been retained

because they may still be in use. Also, “

jargon” not officially

recognized by certifying organizations may continue

to be found in legal reports and is retained here.

ICD codes have been deleted from this edition because

they can be found on the internet and other sources.

The human genome project, DNA breakthroughs in

cellular mechanisms, and changes in therapies have

occurred at a rapid rate. This eighth edition reflects

these new changes, and lots of new information has

been updated.

From its inception, the authors have invited contributors

with expertise in specific areas to review and

update chapters to be current and accurate. The manual

has continued to serve a need, and that is the goal

of this eighth edition.

Fred R.T. Nelson

Carolyn Taliaferro Blauvelt

Preface

ix

No one can write a book on all areas of orthopaedics

and keep it current without the help of many competent

people. This manual is no exception. We have chosen

contributors whose background and experience make

them well qualified to assist in updating material for

each edition and who work directly or indirectly in this

specialty. These people have generously given their time,

in view of other professional commitments, to improve

the correctness and accuracy of information, provide an

update, and give constructive criticism. We can share in

the success of this manual with them, and we wish to

express our appreciation and thanks to our past contributors,

and to the following persons and organizations

who participated in the revisions of the eighth edition.

Classifications of Fractures, Dislocations,

and Sports-Related Injuries

Steven M. Kane, MD

Chairman and Program Director

Orthopaedic Surgery Residency

Atlanta Medical Center

Orthopaedic Residency Program

Atlanta, Georgia

Bruce H. Ziran, MD, FACS

Director of Orthopaedic Trauma

Gwinnett Orthopaedic Trauma

The Hughston Clinic at Gwinnett Medical Center

Lawrenceville, Georgia

Musculoskeletal Diseases and Related Terms

Sheila Ann Conway, MD

Associate Professor, Department of Orthopaedic

Surgery

Program Director, Orthopaedic Surgery Residency

Program

University of Miami/Jackson Memorial Medical

Center

Miami, Florida

Robert J. Esther, MD

University of North Carolina

Department of Orthopaedics

Chapel Hill, North Carolina

Shawn R. Gilbert, MD

Associate Professor of Surgery

University of Alabama at Birmingham

Birmingham, Alabama

Craig S. Roberts, MD, MBA

K. Armand Fischer Professor and Chair

University of Louisville School of Medicine

Department of Orthopaedic Surgery

Louisville, Kentucky

Montri Daniel Wongworawat, MD

Department of Orthopaedic Surgery

Loma Linda University

Loma Linda, California

Contributors

x Contributors

Imaging Techniques

Jean Jose, MD

Associate Professor of Radiology

Associate Chief, Musculoskeletal Radiology

Director, Imaging Sports Medicine

University of Miami Radiology Department

Miami, Florida

Orthopaedic Tests, Signs, and Maneuvers

J. Milo Sewards, MD

Director, Orthopaedic Surgery Residency

Temple University Hospital

Philadelphia, Pennsylvania

Laboratory Evaluations

Sudhaker D. Rao, MD, MB, BS, FACP, FACE

Section Head, Bone and Mineral Metabolism

Director, Bone and Mineral Research Laboratory

Henry Ford Hospital

Detroit, Michigan

Casts, Splints, Dressings, and Traction

Meagan Clark, CPO

Assistant Director of Clinical Education

Loma Linda University, el-MSOP Program

Loma Linda, California

Prosthetic and Orthotics

Meagan Clark, CPO

Assistant Director of Clinical Education

Loma Linda University, el-MSOP Program

Loma Linda, California

Anatomy and Orthopaedic Surgery

Sheila Ann Conway, MD

Associate Professor, Department of Orthopaedic

Surgery

Program Director, Orthopaedic Surgery Residency

Program

University of Miami/Jackson Memorial Medical

Center

Miami, Florida

Robert J. Esther, MD

University of North Carolina

Department of Orthopaedics

Chapel Hill, North Carolina

Shawn R. Gilbert, MD

Associate Professor of Surgery

University of Alabama at Birmingham

Birmingham, Alabama

The Spine

Young Lu, BA

Icahn School of Medicine at Mount Sinai

Department of Orthopaedic Surgery

Mount Sinai Medical Center

New York, New York

Sheeraz Qureshi, MD, MBA

Associate Professor, Orthopaedic Surgery

Minimally Invasive Spinal Surgery

Mount Sinai Hospital

Icahn School of Medicine at Mount Sinai

Co-Director, Spinal Surgery Fellowship

New York, New York

The Hand and Wrist

Montri Daniel Wongworawat, MD

Department of Orthopaedic Surgery

Loma Linda University

Loma Linda, California

The Foot and Ankle

Anthony D. Watson, MD

Greater Pittsburgh Ortho Associates

Pittsburgh, Pennsylvania

Physical Medicine and Rehabilitation:

Physical Therapy and Occupational Therapy

Eugene Bulkin, MD

Assistant Professor

Department of Orthopaedics

Mount Sinai School of Medicine

Port Washington, New York

Contributors xi

Stacy Oster, MS, OTR/L, CHT

Senior Occupational Therapist

Certified Hand Therapist

Beth Israel Medical Center

Phillips Ambulatory Care Center

Department of Rehabilitation Medicine

New York, New York

Paul Zucker, MS, PT, LAc

Director of Ambulatory Services

PACC Administration

Department of Physical Medicine and Rehabilitation

Beth Israel Medical Center

New York, New York

The Research Enterprise

William Wu, PhD

Adjunct Associate Professor of Pharmacology

Wayne State Medical School

Detroit, Michigan

xiii

Orthopaedic (ortho-pae’dic) means correction or prevention

of bony deformities (formerly, especially in

children). The word comes from the Greek orthos,

meaning “straight, upright, right, or true”—hence,

also “correct” or “regular”—and from the Greek pais,

meaning “child.”

The scope of orthopaedic surgery includes the treatment,

management, and rehabilitation of patients with

musculoskeletal conditions affecting bones, muscles,

joints, tendons, ligaments, cartilage, blood vessels,

nerves, and related tissues through surgical, nonsurgical,

and other medical measures. The nature of these

conditions may involve congenital abnormalities, metabolic

disease processes, metastatic (tumor) pathologic

findings, or traumatic injuries (fractures) requiring the

expertise of the orthopaedic specialty. When surgery is

indicated, postoperative rehabilitation is equally important

in the continued care and treatment plan.

The orthopaedic surgeon develops many skills and

must possess a working knowledge of neurology, cardiopulmonary

physiology, and bioengineering in the

care of the orthopaedic patient. This expertise also

includes electrical and magnetic bone stimulation,

microsurgery, and knowledge of internal and external

fixation devices. Orthopaedic medicine is continually

changing, and the orthopaedic surgeon is challenged

with the responsibility of keeping informed of new

techniques through continued education in the field.

Nonoperative measures include everything from the

application of casts for immobilization and management

of fractures or scoliosis to the treatment of diseases and

disabilities through conservative management. In the

operating room, the orthopaedist is skilled in the repair

and reconstruction of major skeletal defects, which

include replacing diseased joints with plastic implants;

inserting metallic rods and other devices for stability;

or performing fusions, revisions, or amputations. Of

a more delicate nature, he or she applies arthroscopic

and microvascular techniques that include skin grafts,

finger transplantations, nerve repairs, and similar difficult

procedures.

The rheumatologist is an internist who specializes in

rheumatic diseases that affect joints, muscles, and soft

tissue. Often they work in collaboration with orthopaedic

surgeons. The osteopathic physician specializes in

orthopaedics with emphasis on body mechanics, or may

specialize in rheumatology.

From a team approach, the orthopaedic specialty

depends on many other disciplines in the treatment of

patients. The immediate team members are the professional

nurses who provide primary care of patients

and who are assisted by orthopaedic technicians, both

in the clinic and hospital setting. The second group

of team members include the physical medicine and

rehabilitation specialists called physiatrists. Physiatrists,

physical therapists, and occupational therapists

are directly involved in, and may be consulted for the

development of a treatment plan in a patient’s rehabilitation.

The next group of team members include the

prosthetists (artificial limbs) and orthotists (braces),

who measure, fit, design, and fabricate expertly applied

devices for the orthopaedic patient. The developers

Introduction to the

Orthopaedic Speciality

xiv Introduction to the Orthopaedic Specialty

and manufacturers of internal orthopaedic appliances

play an important role, as does the researcher who tests

the biocompatibility of materials used in the musculoskeletal

system.

All of these specialties are an integral part of the

orthopaedic team and provide a combination of skills

that benefit thousands of patients with musculoskeletal

problems. Other disciplines that interface with orthopaedics

include bioengineering, electrobiology, transplantation,

diagnostic imaging, oncology, biochemistry,

and similar areas.

Orthopaedic surgery has become so diverse that

there is specialization within the specialty. In addition

to general orthopaedics, a physician may specialize in

diseases and surgery of the spine, soft tissues, the hand,

the foot, major joints, trauma, sports medicine, or

the ever-changing area of orthopaedic research. Many

physicians are exposed to orthopaedic surgery during

their training years, but only a select group actually

pursue this difficult and diverse field to the point of

certification.

The qualification for certification by the American

Board of Orthopaedic Surgery is 5 or 6 years of

postgraduate education after medical school. After

graduation from an Accreditation Council for Graduate

Medical Education–approved 5-year program, a

candidate sits for Part 1, which is a written examination.

After 22 months of practice in the same location,

he or she may sit for Part 2, which is a practice-based

examination reviewing cases and outcomes. The physician

must complete all requirements to become board

certified and a Diplomate of the Board. After completion

of the certification requirements, an orthopaedic

surgeon becomes eligible for Fellowship in the American

Academy of Orthopaedic Surgeons, the national

organization of the specialty. The admission to fellowship

in the Academy requires board certification

and recommendations from the community. This is

typically 18 months following board certification. The

Academy fellowship at present represents approximately

81% of the practicing orthopaedic surgeons in

the United States. The national organization of the

specialty developed the accepted definition of orthopaedics

in 1952:

Orthopaedic Surgery is the medical specialty that

includes the investigation, preservation, restoration,

and development of the form and function of the

extremities, spine, and associated structures by medical,

surgical, and physical methods.

ORTHOPAEDIC ORGANIZATIONS

OF NORTH AMERICA

American Academy for Cerebral Palsy and Developmental

Medicine

American Association for Hand Surgery

American Association of Hip and Knee Surgeons

American Board of Orthopaedic Surgery, Inc.

American Orthopaedic Association

American Orthopaedic Foot and Ankle Society

American Orthopaedic Society for Sports Medicine

American Shoulder and Elbow Surgeons

American Society of Orthopaedic Physician’s

Assistants

American Society of Plastic Surgeons

American Society for Reconstructive Microsurgery

American Society for Surgery of the Hand

American Spinal Injury Association

Arthroscopy Association of North America

Association of Bone and Joint Surgeons

Association of Children’s Prosthetic-Orthotic Clinics

Bones Society, Inc.

Cervical Spine Research Society

Clinical Orthopaedic Society

Clinical Orthopaedics and Related Research (journal)

Council of Musculoskeletal Specialty Societies

Eastern Orthopaedic Association

Federation of Spine Associations

Hip Society

International Cartilage Repair Society

International Society of Arthroscopy, Knee Surgery

and Orthopaedic Sports Medicine

Irish American Orthopaedic Society

J. Robert Gladden Society

Knee Society

Limb Lengthening and Reconstruction Society

Mid-America Orthopaedic Association

Mid-Central States Orthopaedic Society, Inc.

Musculoskeletal Tumor Society

North American Spine Society

Orthopaedic Rehabilitation Association

Orthopaedic Research and Education Foundation

Orthopaedic Research Society

Introduction to the Orthopaedic Specialty xv

Orthopaedic Trauma Association

Osteoarthritis Research Society International

Pediatric Orthopaedic Society of North America

Ruth Jackson Orthopaedic Society

Scoliosis Research Society

SICOT Société Internationale de Chirurgie

Orthopédique

et de Traumatologie

Society of Military Orthopaedic Surgeons

Southern Orthopaedic Association

Western Orthopaedic Association

1

The musculoskeletal reaction to trauma can result in a

variety of bone, muscle, and ligamentous disruptions;

sometimes fracture and ligamentous injuries occur concurrently.

The general types of musculoskeletal trauma

are fractures, dislocations, subluxations, sprains, strains,

and diastases.

This chapter defines fractures and dislocations by

sections. The first part contains general terms that are

easily understood by the nonspecialist, followed by classic,

descriptive, and eponymic terms by anatomic location.

The second section is a brief outline of the AO

(Arbeitsgemeinschaft für Osteosynthesefragen) system

and Orthopaedic Trauma Association Registry System

of fracture classification. The third section defines the

many eponymic classification systems by grades, types,

and mechanisms. The last section covers the types of

dislocations, subluxations, strains and sprains, and

sports-related injuries. Many new terms have been

added to this edition.

Most patients with musculoskeletal injuries present

to an emergency room in an acute stage and are treated

by the emergency room physician until it is determined

that an orthopaedic specialist may be required. Good

communication is essential when relating the assessment

of acute injuries. A brief and accurate description

is vital to the evaluation and immediate treatment of

the injured, and familiarity with the classification systems

that follow will help in understanding the importance

of accurate communication. For example, an

open, midshaft, comminuted, femur fracture gives a

brief description but accurately relates a lot. To achieve

this degree of accuracy, learning the classifications is an

important tool to the end user.

A uniform descriptive system also allows accurate

coding of specific diagnostic entities. The bony detail is

described by the following:

• Open versus closed

• Portion of bone involved

• General appearance

• Alignment of fragments and position and alignment

Interestingly, fractures have specific terminology

that varies from time of occurrence to healing. Fractures

may be named for an anatomic location, a person,

or a place. They are further defined in terms of how they

occurred or reason for the break. As fractures begin to

heal, the degree and nature of healing are described.

Contributing factors, such as tumors, infections,

and repeated stress, are included in the descriptive

terminology. This is important for diagnostic coding.

The management of fractures is also clarified. Closed

management (closed reduction) means that treatment

is in the form of a manipulation, cast, splint–traction

application, or some combination of the three. Open

management (open reduction) requires a surgical incision

to approximate the fracture fragments into normal

position. Often, some form of internal fixation (osteosynthesis)

is performed with open management of fractures.

A fracture of necessity requires surgical fixation

for reduction.

1

Classifications of Fractures,

Dislocations, and Sports-

Related Injuries

A Manual of Orthopaedic 2 thopaedic Terminology

Many advances have been made in the management

of fractures such as immobilization from casting to

bracing, or a combination of both. The term cast brace

has been applied to a form of treatment in which the

brace design is incorporated into temporary standard

cast materials. This method allows for limited motion in

the brace during the early healing stage with controlled

fracture movement. Its use has shown greater callus

formation around the fracture site, improved ligamentous

healing, and earlier recovery of joint mobility and

muscle control.

Another method of fracture management employs

magnetic and electrical bone stimulators, some with

surface electrodes externally applied to a fracture site.

Electromagnetic models use different modalities to

effect an electric field that theoretically will induce

piezoelectric microcurrents that help stimulate bone

formation. Ultrasonic bone stimulation is also used and

has recently been found to be more effective than previously

thought.

An option of traumatic fracture management is the

use of external fixation devices and frames, also called

fixateurs or fixators. External fixation is a diverse system

for managing loss of skeletal stability with various

components placed in bone. Treatment methods

and external skeletal fixation devices are discussed in

Chapter 8. An external fixator is described procedurally

as monoplanar or multiplanar. Fixators applied

to an extremity are most commonly a combination of

monoplanar devices. Two pins with a clamp or connecting

bar between them on any given bone segment

compose a monoplanar fixator. Several monoplanar

segments can be applied and connected to each other

for added stability. An example is a spanning knee

frame, in which a monoplanar fixator to the femur

and a monoplanar fixator to the tibia are connected

to each other. Even though the construct is in more

than one unique plane, the application is more that

of monoplanar devices. Alternatively, the multiplanar

fixator is typically that of the ring or Ilizarov type fixator.

The planning and execution of ringed Ilizarov

fixators is much more difficult and therefore considered

separately.

Other changes to be noticed are the use of modern

technologic terms for implants and procedures. Submuscular

plating involves placing a plate underneath

muscle using peripherally placed cutaneous incisions.

Previously, minimally invasive percutaneous plate

osteosynthesis (MIPPO) and minimally invasive osteosynthesis

(MIO) were terms used to describe the same

technique. Locked screws are another new and novel

development described frequently. This technology

allows for the connection of screw to plate through a

threaded or interference interface. One may also hear

the term internal fixator, which is a mechanical analogy

to that of an external fixator that is “internalized.”

Thus a completely locked plate construct placed in a

minimally invasive fashion has similar mechanical

characteristics to that of an external fixator that is

“internalized.”

Terminology of Fractures

and Dislocations

diastasis: may be one of two types: (1) disjointing of

two bones parallel to one another, for example, radius

and ulna, tibia and fibula complex; or (2) rupture

of any solid joint, as in a diastasis of the symphysis

pubis. Such an injury tends to occur in association

with other fractures and is then called fracture-diastasis.

dislocation: (L., luxatio): complete displacement of

bone from its normal position at the joint surface,

disrupting the articulation of two or three bones at

that junction and altering the alignment. This displacement

affects the joint capsule and surrounding

tissues (muscles, ligaments). Dislocation (luxation)

may be traumatic (direct blow or injury), congenital

(developmental defect), or pathologic (as in muscle

imbalance, ligamentous tearing, rheumatoid arthritis,

or infection).

fracture: (L., fractura): structural break in the continuity

of a bone, epiphyseal plate, or cartilaginous

joint surface, usually traumatic with disruption of

osseous tissue.

fracture-dislocation: fracture of a bone that involves a

dislocation of an adjacent articulation of that bone.

Example: Shoulder fracture dislocation in which

there is a proximal periarticular humerus fracture

with an associated dislocation (not subluxation) of

the humeral head.

Classifications of Fractures, Dislocations, and Sports-Related Injuries 3

sprain-ligament rupture: (L., luxatio imperfecta):

stretching or tearing of ligaments (fibrous bands that

bind bones together at a joint), varying in degrees

from being partially torn (stretched) to being completely

torn (ruptured), with the continuity of the

ligament remaining intact. After a sprain, the fibrous

capsule that encloses the joint may become inflamed,

swollen, discolored, and extremely painful. Involuntary

muscle spasm, and sometimes a fracture, may occur.

Rest, elevation, and a restrictive bandage, splint,

or cast are methods of treating these injuries until

properly healed. When a ligament or tendon has been

torn completely, dislocation may also occur. Surgical

repair may be required in some cases.

strain: stretching or tearing of a muscle or its tendon

(fibrous cord that attaches the muscle to the bone it

moves) may result in bleeding into the damaged muscle

area, which causes pain, swelling, stiffness, muscle

spasm, and, subsequently, a bruise. A strain can be serious

because muscle damage (scar tissue) may cause

muscle shortening. With rest, strains will subside in

2-3 days, but symptoms may persist for months.

subluxation: incomplete or partial dislocation in that one

bone forming a joint is displaced only partially from its

normal position; also, a chronic tendency of a bone to

become partially dislocated, in contrast to an outright

dislocation, for example, shoulder, patella, and hip.

Classifications of Fractures

Open Versus Closed (Fig. 1-1)

closed f.: does not produce an open wound of the skin

but does result in loss of continuity of bone subcutaneously;

formerly called simple f.

open f.: one of the fragments has broken through the

skin, and there is loss of continuity of bone internally;

formerly called compound f.

Portion of Bone Involved

The portion of bone involved or the point of reference

of a fracture may be referred to as the distal third (D/3),

the middle third (M/3), and the proximal third (P/3).

FIG 1-1 Closed versus open fracture.

(From Schneider FR: Handbook for the

orthopaedic assistant, ed 2, St Louis, 1976,

The CV Mosby Co.)

A Manual of Orthopaedic 4 thopaedic Terminology

Middle third fractures are commonly called midshaft

fractures. For specific anatomic locations, the following

terms are commonly used.

apophyseal f.: avulsion of or fracture through an

apophysis (bony prominence) where there is strong

tendinous attachment.

articular f.: involves a joint surface; also called joint f.

and intraarticular f.

cleavage f.: shelling off of cartilage with avulsion of a

small fragment of bone such as the capitellum.

condylar f.: involves any round end of a hinge joint (see

sections on femoral and distal humeral fractures).

cortical f.: involves cortex of bone.

diacondylar f.: transcondylar fracture (line across the

condyles).

direct f.: results at specific point of injury and is due to

the injury itself.

extracapsular f.: occurs near, but outside, the capsule of

a joint, especially the hip; also called extraarticular.

intracapsular f.: occurs within the capsule of a joint;

also called intraarticular.

nonphyseal f.: any childhood fracture that does not

involve a growth plate.

periarticular f.: occurs near but not involving a joint.

transchondral f.: fracture through cartilage, which

may not be apparent unless there is a bone fracture

line into the joint; not to be confused with transcondylar

f.

transcondylar f.: occurs transversely between the condyles

of the elbow. This term is also used in fractures

of the femur and bones with condyles; also called

diacondylar f.

tuft f.: involves the distal phalanx (tuft) of any digit.

General Appearance (Fig. 1-2)

avulsion f.: tearing away of a part; a fragmentation of

bone where the pull of a strong ligamentous or tendinous

attachment tends to forcibly pull the fragment

away from the rest of the bone. The fragment

is usually at the articular surface.

bursting f.: multiple fragments, usually at the end of

a bone; classically, f. of the first cervical vertebra or

the body of the vertebra where there is typically displacement

of bone into the spinal canal.

butterfly f.: a bone fragment shaped like a butterfly

and part of a comminuted; usually involves highenergy

force delivered to the bone.

chip f.: a small fragment, usually at the articular margin

of a joint.

comminuted f.: more than two fragments; described

by degree and quantity of pieces, any third fragment

of bone will constitute some element of comminution.

A butterfly segment is a type of comminution.

Typically, comminution is used to describe multiple

fracture fragments (highly comminuted) versus only

an additional fragment or two (minimally comminuted);

also called splintered fracture or multifragmentary

fracture.

complete f.: the bone is completely broken through

both cortices.

compression f.: crumbling or smashing of cancellous

bone by forces acting parallel to the long axis

of bone; applied particularly to vertebral body

fractures.

depressed f.: typically an intraarticular depression of

fragments, but may also be applied to depressed

skull fractures.

double f.: segmental f. of a bone in two places.

epiphyseal f.: involves the portion of the bone that is

distal to the physis, which is the growth plate.

fissure f.: crack in one cortex (surface) only of a long

bone.

fragility fracture: fracture that occurs with minimal

trauma; caused by osteoporosis.

greenstick f.: in children, incomplete, angulated

fracture with a partial break; also called incomplete

f., interperiosteal f., hickory-stick f., and

willow f.

hairline f.: nondisplaced fracture line (crack) in the

cortex of bone.

impacted f.: fragments are compressed by force of

original injury, driving one fragment of bone into

adjacent bone.

incomplete f.: cortices of bone are buckled or cracked,

but continuity is not destroyed; the cortex is broken

on one side and only bent on the other. Microscopically,

the fracture is present on bent side, and resorption

and callus will occur on this side as well; types

are greenstick f., torus f.

Classifications of Fractures, Dislocations, and Sports-Related Injuries 5

infraction f.: small radiolucent line seen in pathologic

fractures, most commonly resulting from metabolic

problems.

insufficiency f.: a fracture that occurs because bone

is made insufficient as a result of osteoporosis or a

metabolic process.

linear f.: lengthwise fracture of bone straight line fracture;

implies that there is no displacement.

multiple f.: two or more separate lines of fracture in

the same bone.

oblique f.: slanted fracture of the shaft on long axis of

bone.

FIG 1-2 A, Midshaft fractures of the humerus.

1, Comminuted. 2, Transverse, undisplaced.

3, Oblique, undisplaced. 4, Spiral. 5, Segmental.

B, Apposition and alignment of midshaft fractures

of the humerus, anteroposterior view. 1, Perfect

end-to-end apposition, perfect alignment. 2, 50% endto-

end apposition, perfect alignment. 3, Side-to-side

(bayonet) apposition, slight shortening, perfect

alignment. 4, No apposition, approximately

30-degree angulation. (From Mercier LR: Practical

orthopaedics, ed 5, St Louis, 2000, Mosby.)

A

B

A Manual of Orthopaedic 6 thopaedic Terminology

occult f.: hidden fracture (undetectable on a radiograph),

generally occurring in areas of the ribs, tibia,

metatarsals, and navicula.

physeal f: one that involves the cartilaginous growth

plate of a bone; also called epiphyseal slip f., Salter

f., and Salter-Harris f. (Fig. 1-3).

plastic bowing f.: curved deformity of a tubular bone

without gross fracture; also called bowing f., greenstick

f.

secondary f.: pathologic f. of bone weakened by

disease.

segmental f.: several large fractures in the same bone

shaft where the two principal fragments are not

adjacent.

spiral f.: fracture line is spiral shaped, usually on shaft

of long bones where the mechanism of injury is usually

torsion.

stellate f.: numerous fissures radiate from central point

of injury.

subperiosteal f.: bone but not its periosteal tube is

broken; uncommon; usually the result of a direct

blow.

torus f.: usually noticed in children; a stable, often incomplete

f. in which one distal cortical surface appears

to be wrinkled by compression forces, and the

opposite cortex may or may not be infracted by tension

forces.

transverse f.: line of fracture across the shaft at right

angles to the long axis of a bone.

unstable f.: fracture that most often requires operative

intervention because of the likelihood of recurrent

deformity despite manipulation.

Position and Alignment of

Fragments (Fig. 1-4)

The position of a fragment refers to any displacement of

one bone fragment in reference to the next. Displacement,

should it exist, can be in any plane. Alignment

refers to rotatory or angular deviation of the distal fragment

in relation to the proximal fragment. For example:

angulation: typically described by the apex of the

deformity.

An apex anterior angulation means that

the “point” or apex of the fracture is pointed anteriorly.

This could also be described as antecurvatum.

An apex posterior angulation is therefore recurvatum.

bayonet position: the fragments touch and overlap,

but there is good alignment. Internal and external

rotation can also be stated in degrees.

bow: the two fragments form an angle where the apex

is sometimes described as an anterior or posterior

bow.

The descriptive radiographic interpretations of fractures

are defined as follows. The angulation of the fracture

is designated by the direction of the apex of the

fracture points. Fragments themselves are designated as

proximal and distal displacement, which is the amount

of offset of the proximal to distal fragment as seen in

an anterior to posterior or medial to lateral direction.

When broken ends of the principal fragments are

touching, they are said to be in apposition. Accuracy

or degree of apposition is defined in percentages, such

as 50%, indicating at least one radiographic view shows

50% contact and other views may appear to be more.

I II III IV V

FIG 1-3 Epiphyseal fracture types classified by the Salter method.

Classifications of Fractures, Dislocations, and Sports-Related Injuries 7

The site may be diaphyseal, metaphyseal, or epiphyseal

portions of a specific bone or may be intraarticular.

Extent may be described as complete, incomplete,

cracked, hairline, buckled, or greenstick. The configuration

may be transverse, oblique, or spiral, and is referred

to as comminuted when more than two fragments are

present. The fracture fragments may be undisplaced or

displaced.

Thus a fracture is described radiographically by its site,

bone name, extent, configuration, relationship of fragments

to each other and to the external environment (open

or closed), and the presence or absence of complications.

FIG 1-4 Description of fracture deformity.

(From Schneider FR: Handbook for

the orthopaedic assistant, ed 2,

St Louis, 1976, The CV Mosby Co.)

Midline

Apex of fracture

Rotation of

distal fragment

Distal fragment of femur

Valgus

Varus

External Internal

Medial plane

Posterior plane

Lateral plane

Anterior plane

A Manual of Orthopaedic 8 thopaedic Terminology

Classic and Descriptive Names

(By Anatomic Location)

Shoulder Fractures (Proximal Humerus

and Scapula)

anatomic neck f.: occurs in the area of tendinous attachments,

the true neck of humeral metaphysis.

Bankart f.: detachment of a small piece of bone from

the anteroinferior rim of the glenoid; seen with anterior

shoulder dislocation, usually called a Bankart

fragment. The cartilage rim may detach without a

fracture and this is called a Bankart lesion.

coracoid f.: fracture of coracoid process of scapula.

greater tuberosity f.: fracture of bone prominence and

attachment of supraspinatus.

lesser tuberosity f.: fracture of bone prominence for

attachment of subscapularis.

Hill-Sachs f.: moderate compression f. or indentation

f. of the humeral head usually seen after an anterior

dislocation of the shoulder. In a classic Hill-Sachs

lesion the anterior glenoid causes a dent or defect

of the region near the greater tuberosity. A reverse

Hill-Sachs is seen with posterior dislocations, and

where the defect is in the region of the lesser tuberosity;

also called Hermodsson f.

surgical neck f.: occurs in area below the anatomic

neck of the humerus.

Arm and Elbow Fractures

(Distal Humerus)

boxer’s elbow: chip f. at the tip of the olecranon

caused by a fast extension of the elbow in a missed

jab (punch).

condylar f.: occurs at the medial or lateral articular

process of the humerus at the elbow.

epicondylar f.: occurs through one of the two epicondyles,

medial or lateral.

Holstein-Lewis f.: involves the humerus at the junction

of the middle and distal thirds; associated with

radial nerve paralysis because of nerve proximity to

posterior septum and bone.

Kocher f.: semilunar chip f. of capitellum with displacement

into joint.

Laugier f.: involves the trochlea of the humerus.

Malgaigne f.: extension mechanism supracondylar f. of

humerus; name also applied to a vertically dissociated

fracture dislocation of the pelvis and a proximal fibular

fracture.

Posada f.: anteriorly angulated fracture of distal humerus

associated with posterior dislocation of radius

and ulna.

sideswipe f.: comminuted fracture of distal humerus

and sometimes radius and ulna caused by direct

blow against elbow.

supracondylar f.: occurs through the distal metaphysis

of the humerus or femur.

T f.: intercondylar fracture shaped like a T.

Y f.: intercondylar fracture shaped like a Y.

Forearm and Wrist Fractures

Barton f.: an intraarticular fracture of the dorsal rim

of the distal radius, usually resulting in subluxation

of the radial carpal joint with the fracture

site fragment.

chauffeur’s f.: oblique fracture of the radial styloid

caused by a twisting- or snapping-type injury;

also called backfire f., Hutchinson f., and lorry

driver’s f.

chisel f.: incomplete, usually involving medial head of

radius, with fracture line extending distally.

Colles f.: named prior to x-ray technology; implies a

fracture of the distal radius, either articular or nonarticular,

with dorsal angulation of the distal fragment

producing a silver fork deformity; generally

associated with a fracture of the ulnar styloid.

corner f.: a small bucket-handle-appearing fracture in

the distal metaphyseal corner in a young child, often

associated with child abuse.

de Quervain f.: combination of a wrist scaphoid fracture

with volar dislocation of scaphoid fragment and

lunate.

dye-punch f.: an intraarticular fracture of the ulnar

(volar) portion of the distal radius, usually caused by

direct impaction of the lunate onto the lunate fossa

of the distal radius.

Essex-Lopresti f.: a comminuted radial head fracture

with an injury to the distal radioulnar joint caused

by disruption of the interosseous membrane, which

can cause a proximal migration of the radius if the

radial head is excised secondarily.

Classifications of Fractures, Dislocations, and Sports-Related Injuries 9

Galeazzi f.: typically a displaced fracture of the distal

third or quarter of the radius with disruption of the

distal radioulnar joint; called fracture of necessity

because surgical fixation is required for reduction;

also called a reverse Monteggia f., Dupuytren f.,

or Piedmont f.

Kocher f.: fracture of capitellum of distal humerus with

possible displacement of fragment into joint.

Laugier f.: isolated fracture of the trochlea of the humerus

at the elbow.

lead pipe f: typically in the forearm, a combination of

greenstick fracture and torus fracture in the immature

skeleton. Such fractures do not penetrate the

entire shaft of the bone and have the appearance of

a slightly bent lead pipe.

Lenteneur’s f.: a distal radial fracture of the palmar

rim, similar to Smith’s type II fracture.

Monteggia f.: isolated fracture of proximal third of ulna,

with posterior or anterior dislocation of radial head allowing

angulation and overriding of ulnar fragments.

Moore f.: like a Colles f.; specifically, fracture of distal

radius with dorsal displacement of ulnar styloid and

impingement under annular ligament.

Mouchet f.: involves humeral capitellum.

nightstick f.: undisplaced fracture of the ulnar shaft

caused by a direct blow.

Piedmont f.: oblique f. usually at the proximal portion

of distal third of the radius; obliquity runs from

proximal ulnar to distal radial aspect, allowing distal

fragments to be pulled into the ulna by the pronator

quadratus muscle; fracture of necessity requiring

operative management.

radial head f.: involves the most proximal part of the

radius, a dish-shaped portion of bone.

radial styloid f.: involves distal radial tip of radius.

reverse Barton f.: dorsal displacement of carpus on

radius, with associated fracture of dorsal articular

surface of radius. The mechanism and appearance of

this fracture are similar to those of a Colles f.

Skillern f.: open f. of distal radius associated with

greenstick f. of distal ulna.

Smith f.: fracture of the distal radius in which the

distal fragment is displaced volarly; also called

reverse Colles f. This fracture was defined before the

advent of radiography, and, classically, there are

three types:

Nonarticular

Intraarticular; also called volar Barton f.

Oblique nonarticular fracture near the joint line