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Chauffeur fracture

Chauffeur fractures (also known as Hutchinson fractures or backfire fractures) is an intraarticular fracture of the radial styloid process. The radial styloid is within the fracture fragment, although the fragment can vary markedly in size 3.

Mechanism

These injuries are sustained either from direct trauma typically a blow to the back of the wrist or from forced dorsiflexion and abduction. 

The former accounts for its name; trying to start an old-fashioned car with a hand crank sometimes resulted in the crank rapidly spinning backwards (backfire) out of the driver's grasp and striking the back of the wrist 5

The later occurs as the scaphoid forcibly impacts upon the radial styloid and can be considered an avulsion fracture with the radiocarpal ligaments remaining attached to the radial styloid 7

Radiographic features

Plain films usually suffice in the assessment of chauffeur fractures. Along with other distal radial fractures, the AP film can also be used to classify these fractures according to the Frykman classification of distal radial fractures. Chauffeur fractures are considered type III fractures. 

Plain film

The fracture extends proximally in a variably oblique direction (from essentially transverse to almost sagittal) from the distal radial articular surface through the lateral cortex of the distal radius, thus separating the radial styloid from the rest of the radius 4-5. Although often the fracture is undisplaced 5, depending how how sagittal the fracture orientation is, variable proximal migration of the fracture occurs, with an articular step which comes into contact with the scaphoid 4

A number of associated injuries are frequently encountered and may significantly impact on management:

Report checklist

In addition to reporting the presence of the fracture a number of features should be sought and in many instances commented upon as relevant negatives. 

  • fracture
    • direction: transverse/oblique/sagittal 
    • where along the articular surface it begins (especially relative to the scapholunate interval)
    • displacement and articular step-off and gap distance
    • any comminution 
  • associated injuries
    • scapholunate joint space
    • scaphoid fracture
    • carpal alignment (esp. perilunate)
    • ulnar styloid fracture

Treatment and prognosis

Although these fractures are often undisplaced, they are relatively unstable and often benefit from percutaneous lag-screw fixation 6

Etymology

It was originally named by Jonathan Hutchinson (1828-1913) who was a British surgeon. Its other names derive from the typical occupation of people who sustained this injury due to direct trauma from starting a car with a crank. It is also known as backfire fracture or lorry driver fracture 1.

It is interesting to note that the word chauffeur comes from the french for someone who warms the car engine. 

See also


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