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

Anatomic description

Simple, transverse, non-communited midshaft radial and ulnar fracture with 30 degrees apex radial angulation.

Anatomic description

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 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

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