Fracture Classification Amir Hooshang Vahedi MD - Physiatrist.
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Transcript of Fracture Classification Amir Hooshang Vahedi MD - Physiatrist.
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Fracture Classification
Amir Hooshang Vahedi MD - Physiatrist
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Why classify fractures?
Classification or description of fractures is only used when the classification or description is useful in providing treatment or outcomes
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Types of classifications
Anatomic description AO classification Salter-Harris classification Gustillo open fracture classification Fracture specific classifications
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Anatomic description of fractures
Described in specific order Type Comminution Location Displacement
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Anatomic description - Type
Type is the over all fracture pattern
Examples are: Simple, spiral, segmental
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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
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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
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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
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Displacement - Translation
Translation is sideways motion of the fracture - usually described as a percentage of movement when compared to the diameter of the bone.
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Displacement - Angulation
Angulation is the amount of bend at a fracture described in degrees. Also described with respect to the apex of the angle.
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Displacement - Shortening
Shortening is the amount a fracture is collapsed expressed in centimeters. Sometimes called bayonette apposition.
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Anatomic description
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Anatomic description
Simple, transverse, non-communited midshaft radial and ulnar fracture with 30 degrees apex radial angulation.
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Anatomic description
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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.
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AO Classification
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AO Classification - Type A
Type A fracture are extra-artucular 1 - Avulsion fracture 2 - Complete fracture 3 - Comminuted fracture
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AO Classification - Type B
Type B fracture are intra-artucular single condyle fractures
1 - Simple 2 - Crush/depression 3 - Comminuted - split depression
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AO Classification - Type C
Type C fractures are intra-artucular both condyle fractures
1 - Simple 2 - Crush/depression 3 - Comminuted - split depression
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Salter-Harris Classification
Only used for pediatric fractures that involve the growth plate (physis)
Five types (I-V)
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Salter-Harris type I fracture
Type I fracture is when there is a fracture across the physis with no metaphysial or epiphysial injury
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Salter-Harris type II fracture
Type II fracture is when there is a fracture across the physis which extends into the metaphysis
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Salter-Harris type III fracture
Type III fracture is when there is a fracture across the physis which extends into the epiphysis
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Salter-Harris type IV fracture
Type IV fracture is when there is a fracture through metaphysis, physis, and epiphysis
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Salter-Harris type V fracture
Type V fracture is when there is a crush injury to the physis
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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
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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
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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
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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
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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
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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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Fracture Types
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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
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Types of Injuries
Peristitis- inflammation of the periosteum; trauma contusion
Fracture – partial or complete disruption of the bone
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Greenstick Fx
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Longitudinal
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Oblique
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Comminuted
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Spiral
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Open Displaced
Through the skin Not aligned Can have
displaced fx that do not come through the skin
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Transverse/ Nondisplaced
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Avulsion/ Potts Fx
Separation of a bone fragment
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Colles Fx
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Stress Fracture
Overload caused by muscle contraction, altered stress, change in ground reaction, rhythmic repetition
Obvious reaction in the bone
bone scan