1. Fracture Description & Classification
Regions Emergency Medicine

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 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 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 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 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. Thank You!