Classification of fractures in general

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 L earning Objectives With the end of the lecture the student should be able to:-

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 lim b S igns and Symptoms

4. CLASSIFICATION OF FRACTURES

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 CLOSED { Simple} 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 UNDISPLACED 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 Angulatio n 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 Transverse Oblique Spiral Comminuted Segmental 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 TRAUMATIC 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 Classificati on 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

27. 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 5 th metatarsal Green stick # :: unicortical # with bent bones in children

28. 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.

29. 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 ASIS Avulsion JONE’S 5 th MT base Avulsion Fracture Types Anatomical classification of fractures

30. 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

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

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

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

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

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

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

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

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

39.   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: Congenital Traumatic Pathological Paralytic

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

41. Thank You!