Presentation on theme: "Fracture Description & Classification Regions Emergency Medicine."— Presentation transcript:
Fracture Description & Classification Regions Emergency Medicine
Anatomic description of fractures Type Comminution Location Displacement
Anatomic description - Type Type is the overall fracture pattern Examples are: –Simple –Spiral –segmental
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
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
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
Displacement - Translation Translation is sideways motion of the fracture - usually described as a percentage of movement when compared to the diameter of the bone.
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.
Displacement - Shortening Shortening is the amount a fracture is collapsed expressed in centimeters. Sometimes called bayonette apposition.
1 st number = long bone 2 nd number = bone segment Letter = fracture type (A,B,C) Then 3 rd & 4 th numbers classify fracture group & subgroup
Salter-Harris Classification Only used for pediatric fractures that involve the growth plate (physis) Five types (I-V)
Salter-Harris type I fracture Type I fracture is when there is a fracture across the physis with no metaphysial or epiphysial injury
Salter-Harris type II fracture Type II fracture is when there is a fracture across the physis which extends into the metaphysis
Salter-Harris type III fracture Type III fracture is when there is a fracture across the physis which extends into the epiphysis
Salter-Harris type IV fracture Type IV fracture is when there is a fracture through metaphysis, physis, and epiphysis
Salter-Harris type V fracture Type V fracture is when there is a crush injury to the physis
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
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
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
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
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
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