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