fracture classifications in general orthopaedics

1.  Define term the term fracture, dislocation and Subluxation
 Identify the general causes, signs , symptoms of fractures
 Classify the different types of fractures

2. What is fracture(#)?
common causes of
fractures
 Fall from a height
 car accidents
 Direct blow
 Repetitive forces
 Pathology
a BREECH in the continuity of a bone

3.  Swelling or OEDEMA
 pain and tenderness
 Numbness
 Bleeding
 Broken skin with bone protruding
Limitation to move a limb
Signs and Symptoms

5. Why Classify?
• As a treatment guide
• To assist with
prognosis
• To speak a common
language with other
surgeons

6. As a Treatment Guide
• If the same bone is
broken, the surgeon
can use a standard
treatment
• PROBLEM: fracture
personality and
variation with
equipment and
experience

7. To Assist with Prognosis
• You can tell the
patient what to expect
with the results
• PROBLEM: Does not
consider the soft
tissues or other
compounding factors

8. To Speak A Common Language
• This will allow results
to be compared
• PROBLEM: Poor
interobserver
reliability with existing
fracture classifications

9. Intraobserver Reliability
For a given fracture, each physician
should produce the same classification

10. CLASSIFICATION
• Based on Relationship with the environment
• Based on Displacement
• Based on Fracture pattern
• Based on Etiology

11. CLASSIFICATION
Based on relationship with the environment
1. CLOSED { Simple}
2. OPEN {Compound} – within
_ without

12. Closed Fractures
• Fracture is not exposed to the environment
• All fractures have some degree of soft tissue
injury
• Don’t underestimate the soft tissue injury as
this affects treatment and outcome!

13. Open Fractures
• A break in the skin
and underlying soft
tissue leading to a
communicating
fracture hematoma

14. 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
Grade 1— <1cm wound
Grade2 — >1cm wound
Grade 3— subgrades A,B,C

15. CLASSIFICATION
Based on Displacement
1. UNDISPLACED
2. DISPLACED –
• Initial impact
• Pull of surrounding muscles / gravity

16. Displacement - Translation
• Translation is sideways
motion of the fracture -
usually described as a
percentage of movement
when compared to the
diameter of the bone -- ---
-------direction of distal
fragment decides

17. Displacement - Angulation
• Angulation is the
amount of bend at a
fracture described in
degrees. Described
with respect to the
apex of the angle .

18. Displacement - Shortening
• Shortening is the
amount a fracture is
collapsed/ shifted
proximally, expressed
in centimeters.

19. CLASSIFICATION
Based on fracture pattern
1. Transverse
2. Oblique
3. Spiral
4. Comminuted
5. Segmental
6. Stellate

20. Transverse Fracture
A fracture in which the # line is
perpendicular to the long axis of the
bone .
Oblique Fracture
A fracture in which the # line is at oblique
angle to the long axis of the bone.
According to the Path of the # Line
Fracture Types

21. Spiral Fracture
A severe form of oblique fracture in
which the # plane rotates along the long
axis of the bone. These #s occur
secondary to rotational force.
According to the Path of the # Line
Fracture Types

22. Anatomical classification of fractures
Fractures
Comminuted # :
The bone is broken into many
fragments.
Stellate fracture:
This # occurs in the flat bones of the skull
and in the patella, where the fracture lines
run in various directions from one point.

23. CLASSIFICATION
Based on etiology
1. TRAUMATIC
2. PATHOLOGICAL

24. CLASSIFICATION
PATHOLOGICAL
• --- Tumors
• --- Bone cysts
• --- Osteomyelitis
• --- Osteoporosis
• --- Osteogenesis imperfecta
• --- Rickets etc

25. AO/OTA Classification
• Describing the fracture localization: bones
and segments
• 1Humerus
• 2Radius/ulna
• 3Femur
• 4Tibia/fibula

26. AO/OTA Classification
• The identification of the respective segment
needs a little more consideration. Each long
bone has three segments:
• 1 Proximal end segment
• 2 Diaphyseal segment
• 3 Distal end segment

28. CLASSIFICATION
Based on eponyms :
• Colles’ # :: Dinner fork deformity
• Monteggia # D/L :: # proximal 1/3 shaft ulna with
dislocation of head of radius
• Galeazzi # D/L :: # Distal 1/3 shaft Radius with
dislocation of distal radioulnar joint
• Jone’s # :: Avulsion # of base of 5th metatarsal
• Green stick # :: unicortical # with bent bones in
children

29. Anatomical classification of fractures
Impacted fracture:
This # where a vertical force drives the
distal fragment of the fracture into the
proximal fragment.
Fracture Types
Depressed fracture:
This # occurs in the skull where a
segment of bone gets depressed into
the cranium.

30. Avulsion fracture:
This is one, where a chip of bone is avulsed by the sudden and unexpected contraction
of a powerful muscle from its point of insertion,
Examples
1. ASIS Avulsion
2. JONE’S 5th MT base Avulsion
Fracture Types
Anatomical classification of fractures

31. • Stress fracture :
• It is a fracture occurring at a site in the bone subject to
repeated minor stresses over a period of time.
• Birth fracture:
• It is a fracture in the new born
children due to injury during
birth

32. History of Fracture Classification
• 18th & 19th century
– History based on
clinical appearance
of limb alone
Colles Fracture Dinner Fork Deformity

33. Salter-Harris Classification
• Only used for pediatric fractures that involve
the growth plate (physis)
• Five types (I-V)

34. Salter-Harris type I fracture
• Type I fracture is
when there is a
fracture across the
physis with no
metaphysial or
epiphysial injury

35. Salter-Harris type II fracture
• Type II fracture is
when there is a
fracture across the
physis which extends
into the metaphysis

36. Salter-Harris type III fracture
• Type III fracture is
when there is a
fracture across the
physis which extends
into the epiphysis

37. Salter-Harris type IV fracture
• Type IV fracture is
when there is a
fracture through
metaphysis, physis, an
d epiphysis

38. Salter-Harris type V fracture
• Type V fracture is
when there is a crush
injury to the physis

39. What about CT scans & MRI ?
• CT scanning can
assist with fracture
classification
• Example: Sanders
classification of
calcaneal fractures

40. What is Dislocation?
Joints Dislocation
Is the total displacement of the articular end of a bone from the joint cavity.
Subluxation : Is an incomplete displacement.
Reduction : Is the restoration of the normal alignment of the bones.
Classification:
Dislocations are classified
as follows:
A. Congenital
B. Traumatic
C. Pathological
D. Paralytic

41. PIP Joint Subluxation Elbow joint Dislocation.
Dislocation & Subluxation
(Sample Radiographs)

42. Thank You!