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1. ORTHO ANDALAS NOTES @orthopaedi_unand ORTHOPAEDI & TRAUMATOLOGI FAKULTAS KEDOKTERAN UNAND

2. FRACTURE CLASSIFICATIONS FRACTURE CLASSIFICATION ORTHO ANDALAS NOTES

3. FRACTURE CLASSIFICATIONS TABLE OF CONTENT : UPPER LIMB AXIAL LOWER LIMB ORTHO ANDALAS NOTES

4. UPPER LIMB FRACTURE CLASSIFICATION ORTHO ANDALAS NOTES Scapula Acromial Coracoid Clavicle Proximal humerus Shaft humerus Supracondylar humerus Distal humerus Radial head Proximal ulnar Radial shaft Ulna shaft Distal radius Scaphoid Metacarpal Phalanges TABLE OF CONTENT

5. Fracture of Scapula: ZDARKOVIC AND DAMHOLT (BASED ON ANATOMICAL LOCATION) AO/OTA Fracture and Dislocation Classification The scapula is numbered bone 14 : process (14A), body (14B), and glenoid fossa (14F). Anatomic Classification ( Zdravkovic and Damholt ) (Fig. 13.1) Type I: Scapula body Type II: Apophyseal fractures, including the acromion and coracoid Type III: Fractures of the superolateral angle, including the scapular neck and glenoid ORTHO ANDALAS NOTES

6. Ideberg Classification (BASED ON DISPLACEMENT OF THE ARTICULAR COMPONENT) Ideberg Classification of Intra-Articular Glenoid Fractures Type I: Avulsion fracture of the anterior margin Type IIA: Transverse fracture through the glenoid fossa exiting inferiorly Type IIB: Oblique fracture through the glenoid fossa exiting inferiorly Type III: Oblique fracture through the glenoid exiting superiorly and often associated with an acromioclavicular joint injury Type IV: Transverse fracture exiting through the medial border of the scapula Type V: Combination of a type II and type IV pattern Type VI: Comminuted glenoid fracture ORTHO ANDALAS NOTES

7. Classification of Acromial Fractures : KUHN ET AL (BASED ON DISPLACEMENT) Type I: Minimally displaced Type II: Displaced but does not reduce the subacromial space Type III: Displaced with narrowing of the subacromial space ORTHO ANDALAS NOTES

8. Classification of Coracoid Fractures: OGAWA (BASED ON LOCATION FROM CORACOCLAVICULAR LIGAMENT) Type I: Proximal to the coracoclavicular ligament Type II: Distal to the coracoclavicular ligament ORTHO ANDALAS NOTES

9. Clavicle Fracture AO/OTA Fracture and Dislocation Classification 15.1 (proximal [medial]), 15.2 (diaphyseal), and 15.3 (distal [lateral]). The proximal (medial) and distal (lateral) end segments are divided into types A (extraarticular), B (partial articular), and C (complete articular). The diaphyseal seg- ment is divided into types A (simple), B (wedge), and C ( multifragmentary ) ORTHO ANDALAS NOTES

10. Group I: fracture of the middle third (80%). This is the most common fracture in both children and adults; proximal and distal segments are secured by ligamentous and muscular attachments. Group II: fracture of the distal third (15%) Group III: fracture of the proximal third (5%). Minimal displacement results if the costoclavicular ligaments remain intact. It may represent epiphyseal injury in children and teenagers ALLMAN Classification (BASED ON ANATOMICAL LOCATION) ORTHO ANDALAS NOTES

11. Type 1 is a fracture lateral to the coracoclavicular ligament, in which the conoid and trapezoid remain intact, with minimal displacement. Type 2A is a fracture medial to the coracoclavicular ligament, in which the conoid and trapezoid remain intact, with medial clavicle displacement. Type 2B is a fracture that occurs between or lateral to the coracoclavicular ligaments, in which the conoid is torn and the trapezoid may be intact, with medial clavicle displacement. Type 3 is an intra-articular fracture, in which the conoid and trapezoid remain intact, with minimal displacement. Type 4 is a physeal fracture in an immature skeleton, in which the conoid and trapezoid remain intact, with lateral clavicle displacement. Type 5 is a comminuted fracture, in which the conoid and trapezoid remain intact, with medial clavicle displacement. 1 AC, acromioclavicular. NEER CLASIFICATION ( based on the relationship between fractures and the coracoclavicular ligaments ) ORTHO ANDALAS NOTES

12. ACROMIOCLAVICULAR JOINT INJURY ORTHO ANDALAS NOTES

13. ORTHO ANDALAS NOTES

14. Proximal Humerus Fracture AO/OTA Fracture and Dislocation Classification ORTHO ANDALAS NOTES

15. One-part fractures: Nodisplaced fragments regardless of number of fracture lines Two-part fractures (any of the following): Anatomic neck Surgical neck Greater tuberosity Lesser tuberosity Three-part fractures: Surgical neck with greater tuberosity Surgical neck with lesser tuberosity Four-part fractures Fracture-dislocation Articularsurfacefracture NEER Classification (BASED ON PART A FRAGMENT OF FRACTURE) ORTHO ANDALAS NOTES

16. Shaft Humerus Fracture (BASED ON PATTERN OF FRACTURE) AO/OTA Fracture and Dislocation Classification ORTHO ANDALAS NOTES

17. Supracondylar humerUS FRACTURE : GARTLAND (BASED ON THE DEGREE OF DISPLACEMENT) 1. Extension Type This represents 98% of supracondylar humerus fractures in children. This is based on the degree of displacement. Type I: Nondisplaced Type II: Displaced with intact posterior cortex; may be angulated or rotated Type III: Complete displacement; posteromedial or posterolateral 2. Flexion Type This comprises 2% of supracondylar humerus fractures in children. Type I: Nondisplaced Type II: Displaced with intact anterior cortex Type III: Complete displacement; usually anterolateral ORTHO ANDALAS NOTES

18. Distal Humerus Fracture (BASED ON ARTICULAR INVOLVEMENT) AO/OTA Fracture and Dislocation Classification ORTHO ANDALAS NOTES

19. Intercondylar Fracture of Humerus (BASED ON THE DEGREE OF DISPLACEMENT) Riseborough and Radin Type I: Nondisplaced Type II: Slight displacement with no rotation between the condylar fragments Type III: Displacement with rotation Type IV: Severe comminution of the articular surface ORTHO ANDALAS NOTES

20. Lateral and Medial Condyle Fracture of Humerus (BASED ON LOCATION OF THE COMMON FRACTURE LINES) MILCH Type I: Lateral trochlear ridge left intact Type II: Lateral trochlear ridge part of the condylar fragment (medial or lateral) ORTHO ANDALAS NOTES

21. Radial Head Fracture AO/OTA Fracture and Dislocation Classification ORTHO ANDALAS NOTES

22. MASON (BASED ON DEGREE OF DISPLACEMENT AND DISLOCATION) Type I: Nondisplaced fractures Type II: Marginal fractures with displacement (impaction, depression, angulation) Type III: Comminuted fractures involving the entire head Type IV: Associated with dislocation of the elbow (Johnston) ORTHO ANDALAS NOTES

23. Proximal Ulna Fracture AO/OTA Fracture and Dislocation Classification ORTHO ANDALAS NOTES

24. MAYO (BASED ON DISPLACEMENT, COMMINUTION, AND SUBLUXATION OR DISLOCATION) Type I : fractures are nondisplaced or minimally displaced and are subclassified as either noncomminuted (type 1A) or comminuted (type 1B). Type II : fractures have displacement of the proximal fragment without elbow instability Type II A: fractures which are noncomminuted TypeIIB : fractures are comminuted Type III : fractures feature instability of the ulnohumeral joint and require surgical treatment. ORTHO ANDALAS NOTES

25. Schatzker (Based on Fracture Pattern) Transverse : Occurs at the apex of the sigmoid notch and represents an avulsion fracture from a sudden, violent pull of both triceps and brachialis and uncommonly from direct trauma. Transverse-impacted : A direct force leads to comminution and depression of the articular surface. Oblique : Results from hyperextension injury; it begins at midpoint of the sigmoid notch and runs distally. Comminuted fractures with associated injuries : Result from direct high energy trauma ; fractures of the coronoid process may lead to instability. Oblique-distal : Fracture extends distal to the coronoid and compromises elbow stability. Fracture-dislocation : Usually associated with severe trauma. ORTHO ANDALAS NOTES

26. Galeazzi Fracture or Radial Shaft Fracture (Based on Fracture Pattern) AO/OTA Fracture and Dislocation Classification ORTHO ANDALAS NOTES

27. Ulna Shaft Fracture and Monteggia Fracture AO/OTA Fracture and Dislocation Classification ORTHO ANDALAS NOTES

28. Type I: Anterior dislocation of the radial head with fracture of ulnar diaphysis at any level with anterior angulation Type II: Posterior/posterolateral dislocation of the radial head with fracture of ulnar diaphysis with posterior angulation Type III: Lateral/anterolateral dislocation of the radial head with fracture of ulnar metaphysis Type IV: Anterior dislocation of the radial head with fractures of both radius and ulna within proximal third at the same level BADOO Classification of Monteggia (BASED ON DISLOCATION OF RADIAL HEAD) ORTHO ANDALAS NOTES

29. Distal Radius Fracture (based on fracture pattern) AO/OTA Fracture and Dislocation Classification ORTHO ANDALAS NOTES

30. Frykman Classification ( based on the pattern of intra-articular involvement) ORTHO ANDALAS NOTES

31. Type I : Metaphyseal bending fracture with the inherent problems of loss of palmar tilt and radial shortening relative to the ulna (DRUJ injury) Type II : Shearing fracture requiring reduction and often buttressing of the articular segment Type III : Compression of the articular surface without the characteristic fragmentation ; also the potential for significant interosseous ligament injury Type IV : Avulsion fracture or radiocarpal fracture-dislocation Type V : Combined injury with significant soft tissue involvement owing to high-energy injury Fernandez Classification (Based on mechanism) ORTHO ANDALAS NOTES

32. ORTHO ANDALAS NOTES

33. Scaphoid Fracture (based on location of fracture line) Mayo classification (based on location of fracture line) Type I : Distal tubercle fracture Type II : Distal articular surface fracture Type III : Distal third fracture Type IV : Middle third fracture Type V : Proximal third fracture ORTHO ANDALAS NOTES

34. Bannet Fracture ORTHO ANDALAS NOTES

35. Rolando Fracture ORTHO ANDALAS NOTES

36. Metacarpal Fracture ORTHO ANDALAS NOTES

37. Phalang Fracture ORTHO ANDALAS NOTES

38. AXIAL FRACTURE CLASSIFICATION ORTHO ANDALAS NOTES Occipital condyle Atlas Odontoid process Traumatic spondilolystesis Compression Distractive flexion Compressive extension Distractive extension Lateral flexion Clay’s Shoveler Thoracolumbar Burst fracture Flexion-distraction injury TABLE OF CONTENT

39. Occipital Condyle Fractures Type I: Impaction of condyle; usually stable Type II: Shear injury associated with basilar or skull fractures; potentially unstable Type III: Condylar avulsion; unstable ORTHO ANDALAS NOTES

40. Atlas Fractures : LEVINE Isolated bony apophysis fracture Isolated posterior arch fracture Isolated anterior arch fracture Comminuted lateral mass fracture Burst fracture, also known as the Jefferson fracture ORTHO ANDALAS NOTES

41. Fractures of the Odontoid Process (Dens) : ANDERSON AND D’ALONZO Type I: Oblique avulsion fracture of the apex (5%) Type II: Fracture at the junction of the body and the neck; high nonunion rate, which can lead to myelopathy (60%) Type III: Fracture extending into the cancellous body of C2 and possibly involving the lateral facets (30%) ORTHO ANDALAS NOTES

42. Traumatic Spondylolisthesis of C2 (Hangman’s Fracture): LEVINE AND EDWARDS Type I: Nondisplaced, no angulation; translation <3 mm; C2–C3 disc intact (29%); relatively stable Type IA: Atypical unstable lateral bending fractures that are obliquely displaced and usually involve only one pars interarticularis, extending anterior to the pars and into the body on the contralateral side Type II: Significant angulation at C2–C3; translation >3 mm; most common injury pattern; unstable; C2–C3 disc disrupted (56%); subclassified into flexion, extension, and olisthetic types Type IIA: Avulsion of entire C2–C3 intervertebral disc in flexion with injury to posterior longitudinal ligament, leaving the anterior longitudinal ligament intact; results in severe angulation; no translation; unstable; probably caused by flexion-distraction injury (6%); traction contraindicated Type III: Rare; results from initial anterior facet dislocation of C2 on C3 followed by extension injury fracturing the neural arch; results in severe angulation and translation with unilateral or bilateral facet dislocation of C2–C3; unstable (9%); type III injuries most commonly associated with spinal cord injury; frank dislocation; extremely rare ORTHO ANDALAS NOTES

43. INJURIES TO C3–C7 Classification (Allen-Ferguson) Compressive flexion (shear mechanism resulting in “teardrop” fractures) ORTHO ANDALAS NOTES

44. Vertical compression (burst fractures) ORTHO ANDALAS NOTES

45. Distractive flexion (dislocations) ORTHO ANDALAS NOTES

46. Compressive extension ORTHO ANDALAS NOTES

47. Distractive extension ORTHO ANDALAS NOTES

48. Lateral flexion ORTHO ANDALAS NOTES

49. “Clay shoveler’s” fracture ORTHO ANDALAS NOTES

50. Thoracolumbar fracture Compression fractures ( based on end plate involvement ) ORTHO ANDALAS NOTES

51. Burst fractures ( based on end plate involvement ) ORTHO ANDALAS NOTES

52. Flexion–distraction injuries ORTHO ANDALAS NOTES

53. Fracture dislocations (BASED ON MECHANISM OF INJURY) ORTHO ANDALAS NOTES

54. Spondylolysis and Spondylolisthesis ORTHO ANDALAS NOTES

55. ORTHO ANDALAS NOTES

56. LOWER LIMB FRACTURE CLASSIFICATION ORTHO ANDALAS NOTES Pelvic Acetabular Femoral head Femoral neck Intertrochanteric Subtrochanteric Periprosthetic hip Femoral shaft Diaphyseal Femur Distal femur Patella Floating knee Tibial plateau Proximal tibia Tibial shaft Distal tibia TABLE OF CONTENT Pilon Fracture Ankle Calcaneal Tarsometatarsal Metatarsal

57. PELVIC : Young-Burgess Classification (Based on injury mechanism) ORTHO ANDALAS NOTES

58. PELVIC : Young-Burgess Classification Based on injury mechanism. ORTHO ANDALAS NOTES

59. PELVIC : AO / OTA Classification. ORTHO ANDALAS NOTES

60. ACETABULAR : Letournel classification (Based on involvement of acetabular columns and walls) T he five elemental fracture types. a Posterior wall. b Posterior column. c Anterior wall. d Anterior column. E Transverse. ORTHO ANDALAS NOTES

61. ACETABULAR : Letournel classification Based on involvement of acetabular columns and walls T he five associated fracture types. a Posterior column and wall. b Transverse and posterior wall. c T - t y p e . d Anterior column and posterior hemitransverse. e Both columns ORTHO ANDALAS NOTES

62. ACETABULAR : AO / OTA CLASSIFICATION 62A Pelvis, acetabulum, partial articular, isolated column and/or wall fracture 62B Pelvis, acetabulum, partial articular, transverse type fracture 62C Pelvis, acetabulum, complete articular, associated both column fracture ORTHO ANDALAS NOTES

63. Femoral Head: Pipkin Classification (Based on location of fracture relative to fovea and presence or absence of associated fractures of the acetabulum or femoral neck) ORTHO ANDALAS NOTES

64. Femoral Neck: Garden Classification Based on orientation of trabecular lines and displacement ORTHO ANDALAS NOTES

65. Femoral Neck: Pauwels Classification Based on orientation of fracture line ORTHO ANDALAS NOTES

66. Intertrochanteric : Boyd & Griffin Classification Based on the involvement of subtrochanteric region Type I : Stable Type II : Unstsble comminuted Type III : Unxtable reverse oblique Type IV : Intertrochanteric ORTHO ANDALAS NOTES

67. Subtrochanteric : Russell – Taylor Classification based on involvement of lesser trochanter and piriformis fossa ORTHO ANDALAS NOTES

68. AO / OTA Classification Trochanteeric Femur   31A Femur, trochanteric fracture 31B Femur, neck fracture 31C Femur, head fracture ORTHO ANDALAS NOTES

69. The Vancouver classification of periprosthetic hip fractures Vancouver classification (intraoperative)  considerations location pattern stability of fracture types A - proximal metaphysis B - diaphyseal C - distal to stem tip (not amenable to insertion of longest revision stem) subtypes 1 - cortical perforation 2 - nondisplaced crack 3 - displaced unstable fracture pattern ORTHO ANDALAS NOTES

70. Femoral Shaft : Boyd & Griffin Classification Based on the involvement of subtrochanteric region ORTHO ANDALAS NOTES

71. AO / OTA Classification Diaphyseal Femur based on fracture pattern   32A Femur, diaphyseal segment, simple fracture 32B Femur, diaphyseal segment, wedge fracture 32C Femur, diaphyseal segment, multifragmentary fracture ORTHO ANDALAS NOTES

72. AO / OTA Classification Distal Femur Based on articular involvement 33A Femur, distal end segment, extraarticular fracture 33B Femur, distal end segment, partial articular fracture 33C Femur, distal end segment, complete articular fracture ORTHO ANDALAS NOTES

73. AO / OTA Classification Patella Based on articular involvement 34A Patella, extraarticular fracture 34B Patella, partial articular fracture 34C Patella, complete articular fracture, frontal/coronal plane ORTHO ANDALAS NOTES

74. AO / OTA Classification Patella 34A1 Patella, extraarticular, avulsion fracture 34B1 Patella, partial articular, sagittal, lateral fracture 34B2 Patella, partial articular, sagittal, medial fracture 34C1 Patella, complete articular, frontal/coronal, simple fracture 34C2 Patella, complete articular, frontal/coronal, wedge fracture 34C3 Patella, complete articular, frontal/coronal, multifragmentary fracture ORTHO ANDALAS NOTES

75. Fraser classification (Floating knee) Fraser classification (floating knee) Type I: both fractures involve the shaft with articular involvement of the knee. Type II: articular involvement of the knee Type IIa : tibial plateau fractures Type IIb: intercondylar fractures (T or Y fractures) of the inferior extremity of the femur Type IIc : both sites are articular ORTHO ANDALAS NOTES

76. Tibial Plateau Fracture : Skatzker Classification Based on location and depress fracture Schatzker I:  wedge-shaped pure cleavage fracture of the lateral tibial plateau, originally defined as having less than 4 mm of depression or displacement Schatzker II:  splitting and depression of the lateral tibial plateau; namely, type I fracture with a depressed component (generally considered commonest  5 ) Schatzker III:  pure depression of the lateral tibial plateau; divided into two subtypes Schatzker IIIa:  with lateral depression Schatzker IIIb :  with central depression Schatzker IV:  medial tibial plateau fracture with a split or depressed component Schatzker V:  wedge fracture of both lateral and medial tibial plateau Schatzker VI:  transverse tibial metadiaphyseal fracture, along with any type of tibial plateau fracture (metaphyseal-diaphyseal discontinuity) ORTHO ANDALAS NOTES

77. AO / OTA Classification Proximal Tibia 41A Tibia, proximal end segment, extraarticular fracture 41B Tibia, proximal end segment, partial articular fracture 43C Tibia, proximal end segment, complete articular fracture ORTHO ANDALAS NOTES

78.   42A Tibia, diaphyseal segment, simple fracture 42B Tibia, diaphyseal segment, wedge fracture 42C Tibia, diaphyseal segment, multifragmentary fracture AO / OTA Classification Tibial Shaft ORTHO ANDALAS NOTES

79. 43A Tibia, distal end segment, extraarticular fracture 43B Tibia, distal end segment, partial articular fracture 43C Tibia, distal end segment, complete articular fracture AO / OTA Classification Distal Tibia ORTHO ANDALAS NOTES

80. Pilon fracture : Ruedi allgower based on the severity of comminution and the displacement of the articular surface Type I: Nondisplaced cleavage fracture of the ankle joint Type II: Displaced fracture with minimal impaction or comminution Type III: Displaced fracture with significant articular comminution and metaphyseal impaction ORTHO ANDALAS NOTES

81. 44A Tibia/fibula, malleolar segment, infrasyndesmotic fibula injury 44B Tibia/fibula, malleolar segment, transsyndesmotic fibula fracture 44C Tibia/fibula, malleolar segment, suprasyndesmotic fibula fracture AO / OTA Classification Ankle ORTHO ANDALAS NOTES

82. ROTATIONAL ANKLE FRACTURE : LAUGE HANSEN based on “pure” injury sequences, each subdivided into stages of increasing severity This system is based on cadaveric studies. Patterns may not always reflect clinical reality The system takes into account (1) the position of the foot at the time of injury and (2) the direction of the deforming force. ORTHO ANDALAS NOTES

83. ROTATIONAL ANKLE FRACTURE : LAUGE HANSEN 1. Supination–Adduction (SA) This accounts for 10% to 20% of malleolar fractures. This is the only type associated with medial displacement of the talus. Stage I: Produces either a transverse avulsion-type fracture of the fibula distal to the level of the joint or a rupture of the lateral collateral ligaments Stage II: Results in a vertical medial malleolus fracture ORTHO ANDALAS NOTES

84. ROTATIONAL ANKLE FRACTURE : LAUGE HANSEN 2. Supination–External Rotation (SER) This accounts for 40% to 75% of malleolar fractures. Stage I: Produces disruption of the anterior tibiofibular ligament with or without an associated avulsion fracture at its tibial or fibular attachment Stage II: Results in the typical spiral fracture of the distal fibula, which runs from anteroinferior to posterosuperior Stage III: Produces either a disruption of the posterior tibiofibular ligament or a fracture of the posterior malleolus Stage IV: Produces either a transverse avulsion-type fracture of the medial malleolus or a rupture of the deltoid ligament ORTHO ANDALAS NOTES

85. ROTATIONAL ANKLE FRACTURE : LAUGE HANSEN 3. Pronation–Abduction (PA) This accounts for 5% to 20% of malleolar fractures. Stage I: Results in either a transverse fracture of the medial malleolus or a rupture of the deltoid ligament Stage II: Produces either a rupture of the syndesmotic ligaments or an avulsion fracture at their insertion sites Stage III: Produces a transverse or short oblique fracture of the distal fibula at or above the level of the syndesmosis; this results from a bending force that causes medial tension and lateral compression of the fibula, producing lateral comminution or a butterfly fragment ORTHO ANDALAS NOTES

86. ROTATIONAL ANKLE FRACTURE : LAUGE HANSEN 4. Pronation–External Rotation (PER) This accounts for 5% to 20% of malleolus fractures. Stage I: Produces either a transverse fracture of the medial malleolus or a rupture of the deltoid ligament Stage II: Results in disruption of the anterior tibiofibular ligament with or without avulsion fracture at its insertion sites Stage III: Results in a spiral fracture of the distal fibula at or above the level of the syndesmosis running from anterosuperior to posteroinferior Stage IV: Produces either a rupture of the posterior tibiofibular ligament or an avulsion fracture of the posterolateral tibia ORTHO ANDALAS NOTES

87. ROTATIONAL ANKLE FRACTURE : LAUGE HANSEN 5. Danis –Weber This is based on the level of the fibular fracture: the more proximal, the greater the risk of syndesmotic disruption and associated instability. Three types of fractures are described Type A: This involves a fracture of the fibula below the level of the tibial plafond, an avulsion injury that results from supination of the foot and that may be associated with an oblique or vertical fracture of the medial malleolus. This is equivalent to the Lauge –Hansen supination–adduction injury. Type B: This oblique or spiral fracture of the fibula is caused by external rotation occurring at or near the level of the syndesmosis; 50% have an associated disruption of the anterior syndesmotic ligament, whereas the posterior syndesmotic ligament remains intact and attached to the distal fibular fragment. There may be an associated injury to the medial structures or the posterior malleolus. This is equivalent to the Lauge –Hansen supination– external rotation injury. Type C: This involves a fracture of the fibula above the level of the syndesmosis causing disruption of the syndesmosis almost always with associated medial injury. This category includes Maisonneuve-type injuries and corresponds to Lauge –Hansen pronation–external rotation or pronation–abduction stage III injuries. ORTHO ANDALAS NOTES

88. 82A Foot, Calcaneus, extraarticular fracture 82B Foot, Calcaneus, Tongue-type fracture exiting into posterior facet 82C Foot, Calcaneus, complete articular joint depression fracture AO / OTA Classification Calcaneal ORTHO ANDALAS NOTES

89. a Divergent (complete). b Medial divergent (incomplete). c Complete lateral divergent. Lisfranc Fracture-Dislocation Classification Tarsometatarsal ORTHO ANDALAS NOTES

90. AO-ICI Classification Metatarsal ORTHO ANDALAS NOTES

91. Mirels classification for pathological fracture risk Classification 1 point upper limb involving <1/3 of bone diameter blastic /sclerotic lesion mild pain 2 points lower limb involving 1/3-2/3 of bone diameter mixed sclerotic/lytic lesion moderate pain 3 points trochanteric region involves >2/3 of bone diameter lytic lesion functional pain ORTHO ANDALAS NOTES

92. FRACTURE CLASSIFICATIONS THANK YOU