A brief PPT on Fracture types and their Classifications.

1. Fracture Description &
Classification
By Daaneyal J. Dilawar

2. Anatomic description of fractures
 Type
 Comminution
 Location
 Displacement

3. Anatomic description - Type
 Type is the overall
fracture pattern
 Examples are:
– Simple
– Spiral
– segmental

4. 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

5. 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

6. 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

7. Displacement - Translation
 Translation is
sideways motion of
the fracture - usually
described as a
percentage of
movement when
compared to the
diameter of the
bone.

8. 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.

9. Displacement - Shortening
 Shortening is the
amount a fracture is
collapsed expressed
in centimeters.
Sometimes called
bayonette
apposition.

10. Anatomic description?

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

12. Anatomic description??

13. 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.

14. Why classify fractures?
 Classification or description of fractures
is only used when the classification or
description is useful in providing
treatment or outcomes

15. Types of classifications
 Anatomic description
 AO classification
 Salter-Harris classification
 Gustillo open fracture classification
 Fracture specific classifications

16. AO Classification

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

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

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

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

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

22. Salter-Harris type IV fracture
 Type IV fracture is
when there is a
fracture through
metaphysis, physis,
and epiphysis

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

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. Types Of Fractures
 Oblique: Break Occurs Diagonally Across the Bone
 Comminuted: Bone Is Broken, Splintered or Crushed
Into a Number of Pieces
 Spiral: The Break Travels Around the Bone.
 Compound: The Bone Sticks Through the Skin.

31. Types Of Fractures
 Greenstick
– Bone Cracks One Side Only
– Not All the Way Through
– Usually Only Seen in Children Due to Softness of Their Bones
 Transverse: Complete Fracture in Which the Break Is
Straight Across the Bone
 Simple Or Closed
– Partial Break on Bone
– No Open Skin Wound

32. Compound Fracture
 Also Called an Open Fracture
 Occurs When There is a Break in the Skin Around a Broken Bone.
 To Be Classified as Compound Fracture,
– Outside Air (and Dirt and Bacteria) Must Be Able to Get to the
Fracture Site Without a Barrier of Skin or Soft-Tissue.
– Therefore, Bone Does Not Need to be Through the Skin in Order
for the Injury to be Called a Compound Fracture.

33. The Fuss About Compound
Fractures
 Injuries Are Open to the Outside World
– There Is a Very Significant Risk of Developing an
Infection Around the Fracture.
– If Infection Develops, There Can Be Problems with
Healing Process
 Therefore, Compound Fractures Are
Generally Treated with Surgery to Clean the
Site of Injury and Stabilize the Fracture.

34. Compound Fracture X-Ray

35. Spiral Fracture
 Also Called Torsion
Fracture
 Break Spirals Around the
Bone
 Common In a Twisting
Injury
 Can Only Be Caused If a
Limb (Arm or Leg) Is
Twisted in Such a Way
That Causes the Bone to
Break.

36. Spiral Fracture
 Caused by Certain
Types of Accidents
– Especially in Sports,
Especially Skiing
 Abuse
– Arm or Leg is Twisted
by the Abuser

37. Causes Of Spiral Fracture
 In Skiing - skiers lock their feet into the skis in sturdy ski
boots, if a ski breaks or the skier loses control and the
ski rotates, the leg may be violently twisted in one
direction, creating a textbook spiral fracture.
 Spiral Fracture has become famous as a warning sign
of abuse, especially in children, because the twisting
motion necessary could be caused by something such
as a parent or guardian grabbing and twisting the arm
or leg of a child. When doctors see spiral fractures in
children, it may set off warning bells.

38. Sprial Fracture X-Ray

39. Greenstick Fractures
 Commonly Seen in
Children
– Bones Are softer and More
Flexible Than Those of an
Adult, So They're More
Likely to Bend Than Break
Completely
– Flexibility Can Result in a
Greenstick Fracture.
– Bone Cracks but doesn't
Break All the Way Through
- Like When One Tries to
Break a Green Stick of
Wood

40. Greenstick Fractures
 May Occur When a Child Falls While Playing or
Participating in Sports.
 Arm Bones Are the Most Likely to be Harmed
Because of the Instinct to Throw out the Arms
to Catch Fall.
 Can Be Difficult to Diagnose, Because It May
Not Cause All the Classic Signs and Symptoms
of a Broken Bone

41. Greenstick Fracture X-Ray

42. Thank You!