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

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 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 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 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 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

Fracture Types

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

Greenstick Fx

Longitudinal

Oblique

Comminuted

Spiral

Open Displaced Through the skin Not aligned Can have displaced fx that do not come through the skin

Transverse/ Nondisplaced

Avulsion / Potts Fx Separation of a bone fragment

Colles Fx

Stress Fracture Overload caused by muscle contraction, altered stress, change in ground reaction, rhythmic repetition Obvious reaction in the bone bone scan