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A MANUAL OF ORTHOPAEDIC TERMINOLOGY,
EIGHTH EDITION ISBN: 978-0-323-22158-0
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Notices
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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
