Chauffeur fracture
Chauffeur fractures (also known as Hutchinson fractures or backfire fractures) are intra-articular fractures of the radial styloid process. The radial styloid is within the fracture fragment, although the fragment can vary markedly in size.
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Pathology
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 backward (backfire) out of the driver's grasp and striking the back of the wrist 5.
The latter 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 radiograph
The fracture extends proximally in a variable 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 on 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:
- scapholunate dissociation: this is especially true when the fracture line involves the articular surface near the scapholunate interval 7
- trans-scaphoid perilunate dislocation
- ulnar styloid fracture: equates to a Frykman type IV fracture
Treatment and prognosis
Although these fractures are often undisplaced, they are relatively unstable and often benefit from percutaneous lag-screw fixation 6.
History and etymology
It was originally named by British surgeon Jonathan Hutchinson (1828-1913). 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.
Practical points
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 the gap distance
- any comminution
- associated injuries
- scapholunate joint space
- scaphoid fracture
- carpal alignment (especially perilunate)
- ulnar styloid fracture
See also
Related Radiopaedia articles
Fractures
-
fracture
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- fracture location
- diaphyseal fracture
- metaphyseal fracture
- physeal fracture
- epiphyseal fracture
- fracture types
- avulsion fracture
- articular surface injuries
- complete fracture
- incomplete fracture
- infraction
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facial fractures
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spinal fractures
- classification (AO Spine classification systems)
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cervical spine fracture classification systems
- AO classification of upper cervical injuries
- AO classification of subaxial injuries
- Anderson and D'Alonzo classification (odontoid fracture)
- Levine and Edwards classification (hangman fracture)
- Roy-Camille classification (odontoid process fracture )
- Allen and Ferguson classification (subaxial spine injuries)
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cervical spine fracture classification systems
- spinal fractures by region
- spinal fracture types
- classification (AO Spine classification systems)
- rib fractures
- sternal fractures
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upper limb fractures
- classification
- Rockwood classification (acromioclavicular joint injury)
- AO classification (clavicle fracture)
- Neer classification (clavicle fracture)
- Neer classification (proximal humeral fracture)
- AO classification (proximal humeral fracture)
- AO/OTA classification of distal humeral fractures
- Milch classification (lateral humeral condyle fracture)
- Weiss classification (lateral humeral condyle fracture)
- Bado classification of Monteggia fracture-dislocations (radius-ulna)
- Mason classification (radial head fracture)
- Frykman classification (distal radial fracture)
- Mayo classification (scaphoid fracture)
- Hintermann classification (gamekeeper's thumb)
- Eaton classification (volar plate avulsion injury)
- Keifhaber-Stern classification (volar plate avulsion injury)
- upper limb fractures by region
- shoulder
- clavicular fracture
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scapular fracture
- acromion fracture
- coracoid process fracture
- glenoid fracture
- humeral head fracture
- proximal humeral fracture
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- arm
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- wrist
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carpal bones
- scaphoid fracture
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- capitate fracture
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- classification
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- pelvis
- hip
- Pipkin classification (femoral head fracture)
- Garden classification (hip fracture)
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- Cooke and Newman classification (periprosthetic hip fracture)
- Johansson classification (periprosthetic hip fracture)
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- femoral
- knee
- Schatzker classification (tibial plateau fracture)
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- tibia/fibula
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- ankle
- foot
- Berndt and Harty classification (osteochondral lesions of the talus)
- Sanders CT classification (calcaneal fracture)
- Hawkins classification (talar neck fracture)
- Myerson classification (Lisfranc injury)
- Nunley-Vertullo classification (Lisfranc injury)
- pelvis and lower limb fractures by region
- pelvic fracture
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hip
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femoral neck fracture
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trochanteric fracture
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- knee
- avulsion fractures
- Segond fracture
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- anterior cruciate ligament avulsion fracture
- posterior cruciate ligament avulsion fracture
- arcuate complex avulsion fracture (arcuate sign)
- biceps femoris avulsion fracture
- iliotibial band avulsion fracture
- semimembranosus tendon avulsion fracture
- Stieda fracture (MCL avulsion fracture)
- patellar fracture
- tibial plateau fracture
- avulsion fractures
- leg
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- fibular shaft fracture
- Maisonneuve fracture
- ankle
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Wrist pathology
- alignment
- wrist fractures and dislocations
- distal radial fracture
- pediatric
- carpal bones
- carpal instability
- osteonecrosis
- triangular fibrocartilaginous complex (TFCC) injuries
- ulnar-sided wrist impaction and impingement syndromes
- soft tissue and tendons
- arthritides