Classification of fractures-2.pptx

Classification of fracture

1. CLASSIFICATION OF FRACTURES Dhanya Krishnan Evelin Thomas Kaliyadan

2. CLASSIFICATION Based on Relationship with the Environment Based on Displacement Based on Fracture Pattern Based on Etiology Based on Complexity of treatment Based on Force causing fracture

3. Classification Based on Relationship with Environment 1.Closed fracture : no communication with external envt ; ov erlying tissue and skin are intact. 2.Open fracture :communication with ext envt present; break in ov erlying soft tissue and skin.

4. Open Fractures Fracture with break in overlying skin and soft tissues Fracture communicates with the external environment Internally open (from within):sharp fracture end pierces skin from within Externally open(open from outside):object causing fracture lacerates the skin and soft tissues over the bone as it breaks the bone

5. Gustillo Classification The Gustillo classification is used to classify open fractures. Three grades that try to quantify the amount of soft tissue damage associated with the fracture Grade 1 — <1cm wound, minimum soft t/s injury Grade 2 — >1cm wound, moderate soft t/s injury Grade 3 — >10cm wound, severe muscle devitalization Grade 3 has subgrades A, B ,C.

6. GUSTILO CLASSIFICATION

7. Grade 3A Limited stripping of periosteum and soft tissue from bone. Adequate soft tissue coverage for bone, tendons and neurovascular bundle.

8. Grade 3B Extensive stripping of soft tissue and periosteum from bone. Requires a local flap or free tissue transfer Grade 3C A major vascular injury requiring repair

9. Muller’s Classification Each long bone has 3 segments Proximal, Diaphyseal and Distal Diaphyseal Fractures: Simple Wedge Complex Proximal & Distal Extra-Articular Partial Articular Complete Articular

10. Classification: Based on Displacement UNDISPLACED DISPLACED

11. Displaced fracture A fracture may be displaced Factors responsible for displacement The fracturing force Muscle pull on fracture fragments gravity

12. 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

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

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

15. Classification: Based on Pattern Transverse Oblique Spiral Comminuted Segmental Stellate

16. Transverse Fracture A fracture in which fracture line is perpendicular to the long axis of the bone . Caused by bending or tapping force. Oblique Fracture A fracture in which the fracture line is at oblique angle to the long axis of the bone. Caused by bending force. According to the Path of Fracture Line

17. Spiral Fracture :- A severe form of oblique fracture in which the fracture line runs spirally in more than one plane. These fractures occur primarily to a twisting force. According to the Path of fracture Line

18. Anatomical Classification of Fractures Comminuted Fracture : The bone is broken into many fragments. Caused by crushing or compressed force. Segmental Fracture: In this type of fracture , there are two types of fractures in one bone, but at different levels.

19. Anatomical Classification of Fractures Impacted Fracture: This fracture where a vertical force drives the distal fragment of the fracture into the proximal fragment. Depressed Fracture : This fracture occurs in the skull where a segment of bone gets depressed into the cranium.

20. Avulsion Fracture: A chip of bone is avulsed by the sudden and unexpected contraction of a powerful muscle from its point of insertion, Examples:- Anterior superior iliac spine avulsion. JONE’S 5 th metatarsal base avulsion. Anatomical Classification of Fractures

21. 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 Anatomical Classification of Fractures

22. Classification: Based on Etiology TRAUMATIC PATHOLOGICAL Tumors(metastasis) Bone cysts Osteomyelitis Osteoporosis Osteogenesis imperfecta (Brittle bone d/s) Rickets

23. Salter-Harris Classification Only used for pediatric fractures that involve the growth plate ( physis )

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

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

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

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

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

29. Based on complexity of treatment Simple :fracture in two pieces usually easy to treat.eg; transverse fracture of humerus Complex : fracture in multiple pieces usually difficult to treat.eg;comminuted fracture of tibia

30. Based on force causing fracture High velocity injury : fractures sustained due to trauma, soft tissue injury. There is extensive devascularisation . It is slow to heal. Low velocity injury : fractures due to a fall,little soft tissue injury , fracture heals predictably.

31. FRACTURE WITH EPONYMS MONTEGGIA FRACTURE DISLOCATION :fracture of proximal third of ulna ,with dislocation of head of radius. GALEAZZI FRACTURE DISLOCATION:fracture of distal third of radius with dislocation of distal radio ulnar joint COLLE’S FRACTURE:A fracture occuring in adults at the cortico cancellous junction at the distal end of radius with central tilt and other displacements.