Ankle Fracture Eponyms
Ankle Fracture Eponyms
C OPYRIGHT 2013
BY
T HE J OURNAL
OF
B ONE
AND J OINT
S URGERY, I NCORPORATED
the
Orthopaedic
forum
Ankle Fracture Eponyms
M.P. Somford, MD, J.I. Wiegerinck, MD, D. Hoornenborg, MD, and M.P.J. van den Bekerom, MD
The acute ankle fracture has often been cited as one of the most
commonly treated musculoskeletal injuries. As such, considerable research has been conducted, along with many clinical
studies, aiming to evaluate conservative versus surgical management, as well as radiographic classifications and long-term
outcomes. Several types of ankle fractures are known historically by their eponyms. Eponyms are frequently used in orthopaedic surgery to denominate fractures, fracture-dislocations,
and classifications, which are most commonly named after the
physicians who first described them.
In 2007, a debate entitled Should Eponyms Be Abandoned? evoked strong responses both in favor and against the
use of medical eponyms, and added interesting insights into
their current use1,2. The opponents of the use of eponyms in
the medical literature recommend abandoning them because
they lack accuracy, lead to confusion, and hamper scientific
discussion in a globalized world.1 Some disadvantages are obvious. Some eponyms do not refer to the correct person but to a
later researcher who made the same discovery. For example John
Langdon Down did not discover the syndrome mongolism,
but rather coined the term, which was later changed to Down
syndrome because the former name was considered racist. Additionally, the person behind a medical eponym might have been
involved in crimes against humanity, as was the case with Hans
Conrad Julius Reiter in Nazi Germany. Other disadvantages are
subtle. For example, pronunciation and spelling may be incorrect. Foreign eponyms that have diacritics (e.g., acute or grave
accents) are often misspelled or mispronounced. Sometimes it is
hard to establish the exact spelling when you hear someone using
an eponym. Finally, an eponymous fracture or classification system is only clinically relevant when it has consequences for
treatment or when it influences prognosis. This has resulted in
abandoning the scientific use of many of eponyms.
In contrast to these opinions, proponents advocate retention of eponyms because they are often practical and a
form of medical shorthand, and bring color to medicine
and they embed medical traditions and culture in our history.2
Appropriate and uniform use of nomenclature regarding an
ankle fracture, for example, is vital for the care of patients who
sustain one since it is used for identification, classification, and
retrieval of information from databases and therefore often
used by health-care providers when discussing treatment3,4.
The aim of this uniformity is to provide a flexible, practical,
and scientifically acceptable term to describe a fracture and
ensure clarity when discussing it. This promotes communication among colleagues, facilitates consistency in spelling, and
avoids confusion in both the basic and clinical sciences5.
The objective of this article is to summarize and describe
the most commonly used ankle fracture eponyms (Fig. 1). The
first goal is to give some information about the people whose
names are connected with these fractures, and the second goal
is to provide a clear definition of the various ankle fractures.
Because the history behind the eponym often remains obscure
or unknown to the user, it is hoped that this report will serve as
a resource and will aid in the preservation of orthopaedic history and prevent confusion when these eponyms are used.
Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any
aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work,
with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has
had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in
this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.
http://dx.doi.org/10.2106/JBJS.M.00198
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Fig. 1
Pott Fracture
Percivall Pott was born on January 6, 1714 in London on the
present site of the Bank of England. Although educated to
become a clergyman, he was apprenticed to become a surgeon
at St. Bartholomews Hospital in 1729, and he became an assistant surgeon in 1745. In 1749, he became a full surgeon, and
he remained in this position until his retirement in 1787. In his
own words, he served the institution as a boy and a man.6 In
1756, he was thrown off of his horse while riding to the Lock
Hospital. He sustained a compound fracture of the ankle. If not
for his mentor, Edward Nourse, the leg would have been amputated, a common practice in those days. Instead, the fracture
was reduced, and it healed over time. After a lengthy recuperation from the fracture, Pott wrote surgical textbooks; in 1768,
he described the fracture that he himself had sustained with the
following classic description:
When the fibula breaks within two or three inches of its
lower extremity, the inferior fractured end falls inwards towards
the tibia, that extremity of the bone which forms the outer ankle
is turned somewhat outward and upward, and the tibia having
lost its proper support is forced off from the astragalus inwards,
by which means the weak bursal or common ligament of the
joint is violently stretched if not torn, and the strong ones which
fasten the tibia to the astragalus and os calcis are always lacerated,
thus producing a perfect fracture and a partial dislocation to
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A Pott fracture is a fracture-dislocation of the ankle, involving a fracture of the fibula, disruption of the deltoid ligaments, and an intact tibiofibular ligament. This results in a
lateral displacement of the talus.
Dupuytren Fracture
Guillaume Dupuytren (Fig. 2) was born the son of an impoverished advocate in Pierre-Buffie` re, France, on October 5, 1777.
Although he wanted a career in the army, his father convinced
him to get into the medical profession. He studied in Paris beginning at age sixteen. It is said that he was so impoverished that
he took the fat of the cadavers used for dissection education to
make oil for his lamp. At the age of eighteen, he became prosector at his medical school and was in charge of all autopsies. In
1803, he acquired his doctorate from the University of Paris,
which was delayed because of the suppression of medical schools
by the revolutionary government. In 1808, he became a surgeon
at the Hotel-Dieu
in Paris. Beginning in 1815, he held the position of chief of surgery there for more than twenty years. His
merciless, obsessive-compulsive personality and absolute perfectionism gained him the nicknames Brigand dHo tel-Dieu,
Napoleon of surgery, and first among surgeons, last among
men.10 However, he was a great lecturer with an amazing memory for case histories, medical studies, and details, making him
an outstanding diagnostician and teacher.
Because Dupuytren loathed writing, his students published his lectures and investigations. These reports cover the
entire surgical field of that time. In his prime, Dupuytren saw
10,000 patients a year. The money that he acquired was once
used to help Charles X, who was dethroned and in need of
money. A gift of one million francs came with the notion that
Charles could receive another million for his daughter and a
third for his old age, but the king declined. Dupuytren was made
a baron by Louis XVIII and was also appointed his personal
surgeon. In addition, he was the first surgeon to Charles X.
Fig. 2
Fig. 3
Fig. 4
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Fig. 5
A N K L E F R AC T U R E E P O N Y M S
Fig. 6
Fig. 7
Fig. 8
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Fig. 9
A N K L E F R AC T U R E E P O N Y M S
Fig. 10
expeditions to Iceland and the Faroe Islands. In 1942, he published his thesis Ankelbrud (ankle fracture) while working at
the Bispebjerg Hospital in Copenhagen. Beginning in 1943, he
worked as head of the radiology department of the Central
Hospital in Randers. In 1950, he became a member of the main
board of the National Association for Combating Rheumatic
Diseases. From 1959 to 1961, he worked in Seoul, South Korea,
and was made an honorary member of the Korean Medical
Association.
Lauge-Hansen was a man of short stature who hated to
look up to others. As a result, he arranged for the legs of two
chairs used at his desk by visitors to be shortened. By reports,
this desk is still in use in the radiology department of the
Central Hospital in Randers. With use of cadaver specimens
in the 1940s and 1950s, he elucidated the mechanisms involved
in ankle fractures. He wrote his key publications on the subject,
five articles describing five basic mechanisms of ankle injury,
between 1948 and 1956.
This classification system was based on the stability of the
ankle mortise, not only the dislocation and the type of fibular
fracture. As defined by Lauge-Hansen, the five basic mechanisms
of ankle injury are described by two words. The first word refers
to the initial position of the foot at the time of injury; the second
word describes the direction of the injuring force through
the talus. This results in the following possible mechanisms:
supination-adduction, supination-eversion, pronation-eversion,
pronation-abduction, and pronation-dorsiflexion29-33. The trauma
mechanism is meant to guide one to the fracture type and vice
versa, although this is not always easily achieved in daily practice.
He created a very complete but quite complicated classification
system. Because of its complexity, the classification system is not
always used, ironically not even in the Central Hospital in Randers (personal communication).
Danis-Weber Classification
Robert Danis (Fig. 11) was born in Oudenaarde, Belgium, in
1880. He studied in Brussels and graduated in 1904. He first
Fig. 11
Lauge-Hansen Classification
Niels Lauge-Hansen (Fig. 10), the son of a farmer in Jerne, Denmark, was born on May 21, 1899. In 1925, he finished his study of
medicine. From 1926 to 1927, he served in the navy, undertaking
Fig. 12
Fig. 11 Robert Danis. (Reproduced with permission from the AO Foundation, Davos, Switzerland [www.aofoundation.org].) Fig. 12 Bernhard Georg
Weber. (Reproduced with permission from the AO Foundation, Davos,
Switzerland [www.aofoundation.org].)
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M.P. Somford, MD
J.I. Wiegerinck, MD
D. Hoornenborg, MD
M.P.J. van den Bekerom, MD
Department of Orthopaedic Surgery,
Academic Medical Centre,
Meibergdreef 15, P.O. Box 22660,
1105 AZ, Amsterdam, The Netherlands.
E-mail address for M.P. Somford: mp_somford@hotmail.com
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