Fracture Description & Classification

Regions Emergency Medicine

Anatomic description of fractures

Type Comminution Location Displacement

Anatomic description - Type

Type is the overall 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. Described with respect to the apex of the angle or with respect to direction of distal fragment.

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.

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

AO Classification

AO Classification

1st number = long bone 2nd number = bone segment Letter = fracture type (A,B,C) Then 3rd & 4th numbers classify fracture group

& subgroup

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

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