Fracture Description & Classification Regions Emergency Medicine.
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Transcript of Fracture Description & Classification Regions Emergency Medicine.
![Page 1: Fracture Description & Classification Regions Emergency Medicine.](https://reader035.fdocuments.net/reader035/viewer/2022062404/551bd4d0550346b4588b56d1/html5/thumbnails/1.jpg)
Fracture Description & Classification
Regions Emergency Medicine
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Anatomic description of fractures
Type Comminution Location Displacement
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Anatomic description - Type
Type is the overall fracture pattern
Examples are: – Simple – Spiral– segmental
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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
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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
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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
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Displacement - Translation
Translation is sideways motion of the fracture - usually described as a percentage of movement when compared to the diameter of the bone.
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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.
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Displacement - Shortening
Shortening is the amount a fracture is collapsed expressed in centimeters. Sometimes called bayonette apposition.
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Anatomic description?
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Anatomic description
Simple, transverse, non-communited midshaft radial and ulnar fracture with 30 degrees apex radial angulation.
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Anatomic description??
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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.
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Why classify fractures?
Classification or description of fractures is only used when the classification or description is useful in providing treatment or outcomes
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Types of classifications
Anatomic description AO classification Salter-Harris classification Gustillo open fracture classification Fracture specific classifications
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AO Classification
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AO Classification
1st number = long bone 2nd number = bone segment Letter = fracture type (A,B,C) Then 3rd & 4th numbers classify fracture group
& subgroup
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Salter-Harris Classification
Only used for pediatric fractures that involve the growth plate (physis)
Five types (I-V)
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Salter-Harris type I fracture
Type I fracture is when there is a fracture across the physis with no metaphysial or epiphysial injury
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Salter-Harris type II fracture
Type II fracture is when there is a fracture across the physis which extends into the metaphysis
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Salter-Harris type III fracture
Type III fracture is when there is a fracture across the physis which extends into the epiphysis
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Salter-Harris type IV fracture
Type IV fracture is when there is a fracture through metaphysis, physis, and epiphysis
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Salter-Harris type V fracture
Type V fracture is when there is a crush injury to the physis
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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
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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
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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
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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
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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
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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
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Thank You!