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.
Anatomic description Simple, transverse, non-communited midshaft radial and ulnar fracture with 30 degrees apex radial angulation.
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.
Why classify fractures? Classification or description of fractures is only used when the classification or description is useful in providing treatment or outcomes
Types of classifications Anatomic description AO classification Salter-Harris classification Gustillo open fracture classification Fracture specific classifications
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 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 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 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 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