Fracture Classification Amir Hooshang Vahedi MD - Physiatrist
Why classify fractures? • Classification or description of fractures is only used when the classification or description is useful in providing treatment or outcomes
Types of classifications • Anatomic description • AO classification • Salter-Harris classification • Gustillo open fracture classification • Fracture specific classifications
Anatomic description of fractures • Described in specific order • Type • Comminution • Location • Displacement
Anatomic description - Type • Type is the over all fracture pattern • Examples are: Simple, spiral, segmental
Anatomic description - Communition • Comminution is the measure of the number of pieces of broken bone that there are. • Examples are: non-comminuted or mildly comminuted or severely comminuted
Anatomic description - Location • Location is the anatomic location of the fracture usually described by giving the bone involved and location on the bone • Examples are: distal radial shaft, proximal 1/3 humeral shaft, intra-articular distal tibial
Anatomic description - Displacement • Displacement is the amount the pieces of a fracture have moved from their normal location • Can be displaced or non-displaced • Subdivided into 3 sub-categories: translation, angulation, and shortening
Displacement - Translation • Translation is sideways motion of the fracture - usually described as a percentage of movement when compared to the diameter of the bone.
Displacement - Angulation • Angulation is the amount of bend at a fracture described in degrees. Also described with respect to the apex of the angle.
Displacement - Shortening • Shortening is the amount a fracture is collapsed expressed in centimeters. Sometimes called bayonette apposition.
Anatomic description • Simple, transverse, non-communited midshaft radial and ulnar fracture with 30 degrees apex radial angulation.
Anatomic description • Simple, transverse, non-communited distal radial and ulnar fracture with 100% radial translation, 45 degrees apex ulnar angulation and 2 cm of shortening.
AO Classification - Type A • Type A fracture are extra-artucular • 1 - Avulsion fracture • 2 - Complete fracture • 3 - Comminuted fracture
AO Classification - Type B • Type B fracture are intra-artucular single condyle fractures • 1 - Simple • 2 - Crush/depression • 3 - Comminuted - split depression
AO Classification - Type C • Type C fractures are intra-artucular both condyle fractures • 1 - Simple • 2 - Crush/depression • 3 - Comminuted - split depression
Salter-Harris Classification • Only used for pediatric fractures that involve the growth plate (physis) • Five types (I-V)
Salter-Harris type I fracture • Type I fracture is when there is a fracture across the physis with no metaphysial or epiphysial injury
Salter-Harris type II fracture • Type II fracture is when there is a fracture across the physis which extends into the metaphysis
Salter-Harris type III fracture • Type III fracture is when there is a fracture across the physis which extends into the epiphysis
Salter-Harris type IV fracture • Type IV fracture is when there is a fracture through metaphysis, physis, and epiphysis
Salter-Harris type V fracture • Type V fracture is when there is a crush injury to the physis
Gustillo classification • The Gustillo classification is used to classify open fracture - ones in which the skin has been disrupted • Three grades that try to quantify the amount of soft tissue damage associated with the fracture
Open fractures - grade 1 • wound less than 1 cm w/ minimal soft tissue injury • wound bed is clean • bone injury is simple w/ minimal comminution • w/ IM nailing, average time to union is 21-28 weeks
Open fractures - grade 2 • wound is greater than 1 cm w/ moderate soft tissue injury • wound bed is moderately contaminated • fracture contains moderate comminution • w/ IM nailing, average time to union is 26-28 weeks
Open fractures - grade 3A • wound greater than 10 cm w/ crushed tissue and contamination • soft tissue coverage of bone is usually possible • w/ IM nailing, average time to union is 30-35 weeks
Open fractures - grade 3B • wound greater than 10 cm w/ crushed tissue and contamination • soft tissue is inadequate and requires regional or free flap • w/ IM nailing, average time to union is 30-35 weeks
Open fractures - grade 3C • is fracture in which there is a major vascular injury requiring repair for limb salvage • fractures can be classified using the MESS • in some cases it will be necessary to consider BKA following tibial fracture
Bone will bend • It is a poor shock absorber • Stress forces become concentrated where a long bone suddenly changes shape and direction • Long bones can be stressed by tension, compression, bending, torsion, shearing
Types of Injuries • Peristitis- inflammation of the periosteum; trauma contusion • Fracture – partial or complete disruption of the bone
Open Displaced • Through the skin • Not aligned • Can have displaced fx that do not come through the skin
Avulsion/ Potts Fx • Separation of a bone fragment