Classification of fractures in general
- 1. Define term the term fracture, dislocation and Subluxation Identify the general causes, signs , symptoms of fractures Classify the different types of fractures
- 2. What is fracture(#)? common causes of fractures Fall from a height car accidents Direct blow Repetitive forces Pathology a BREECH in the continuity of a bone
- 3. Swelling or OEDEMA pain and tenderness Numbness Bleeding Broken skin with bone protruding Limitation to move a limb Signs and Symptoms
- 5. Why Classify? • As a treatment guide • To assist with prognosis • To speak a common language with other surgeons
- 6. As a Treatment Guide • If the same bone is broken, the surgeon can use a standard treatment • PROBLEM: fracture personality and variation with equipment and experience
- 7. To Assist with Prognosis • You can tell the patient what to expect with the results • PROBLEM: Does not consider the soft tissues or other compounding factors
- 8. To Speak A Common Language • This will allow results to be compared • PROBLEM: Poor interobserver reliability with existing fracture classifications
- 9. Intraobserver Reliability For a given fracture, each physician should produce the same classification
- 10. CLASSIFICATION • Based on Relationship with the environment • Based on Displacement • Based on Fracture pattern • Based on Etiology
- 11. CLASSIFICATION Based on relationship with the environment 1. CLOSED { Simple} 2. OPEN {Compound} – within _ without
- 12. Closed Fractures • Fracture is not exposed to the environment • All fractures have some degree of soft tissue injury • Don’t underestimate the soft tissue injury as this affects treatment and outcome!
- 13. Open Fractures • A break in the skin and underlying soft tissue leading to a communicating fracture hematoma
- 14. 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 Grade 1— <1cm wound Grade2 — >1cm wound Grade 3— subgrades A,B,C
- 15. CLASSIFICATION Based on Displacement 1. UNDISPLACED 2. DISPLACED – • Initial impact • Pull of surrounding muscles / gravity
- 16. Displacement - Translation • Translation is sideways motion of the fracture - usually described as a percentage of movement when compared to the diameter of the bone -- --- -------direction of distal fragment decides
- 17. Displacement - Angulation • Angulation is the amount of bend at a fracture described in degrees. Described with respect to the apex of the angle .
- 18. Displacement - Shortening • Shortening is the amount a fracture is collapsed/ shifted proximally, expressed in centimeters.
- 19. CLASSIFICATION Based on fracture pattern 1. Transverse 2. Oblique 3. Spiral 4. Comminuted 5. Segmental 6. Stellate
- 20. Transverse Fracture A fracture in which the # line is perpendicular to the long axis of the bone . Oblique Fracture A fracture in which the # line is at oblique angle to the long axis of the bone. According to the Path of the # Line Fracture Types
- 21. Spiral Fracture A severe form of oblique fracture in which the # plane rotates along the long axis of the bone. These #s occur secondary to rotational force. According to the Path of the # Line Fracture Types
- 22. Anatomical classification of fractures Fractures Comminuted # : The bone is broken into many fragments. Stellate fracture: This # occurs in the flat bones of the skull and in the patella, where the fracture lines run in various directions from one point.
- 23. CLASSIFICATION Based on etiology 1. TRAUMATIC 2. PATHOLOGICAL
- 24. CLASSIFICATION PATHOLOGICAL • --- Tumors • --- Bone cysts • --- Osteomyelitis • --- Osteoporosis • --- Osteogenesis imperfecta • --- Rickets etc
- 25. AO/OTA Classification • Describing the fracture localization: bones and segments • 1Humerus • 2Radius/ulna • 3Femur • 4Tibia/fibula
- 26. AO/OTA Classification • The identification of the respective segment needs a little more consideration. Each long bone has three segments: • 1 Proximal end segment • 2 Diaphyseal segment • 3 Distal end segment
- 28. CLASSIFICATION Based on eponyms : • Colles’ # :: Dinner fork deformity • Monteggia # D/L :: # proximal 1/3 shaft ulna with dislocation of head of radius • Galeazzi # D/L :: # Distal 1/3 shaft Radius with dislocation of distal radioulnar joint • Jone’s # :: Avulsion # of base of 5th metatarsal • Green stick # :: unicortical # with bent bones in children
- 29. Anatomical classification of fractures Impacted fracture: This # where a vertical force drives the distal fragment of the fracture into the proximal fragment. Fracture Types Depressed fracture: This # occurs in the skull where a segment of bone gets depressed into the cranium.
- 30. Avulsion fracture: This is one, where a chip of bone is avulsed by the sudden and unexpected contraction of a powerful muscle from its point of insertion, Examples 1. ASIS Avulsion 2. JONE’S 5th MT base Avulsion Fracture Types Anatomical classification of fractures
- 31. • Stress fracture : • It is a fracture occurring at a site in the bone subject to repeated minor stresses over a period of time. • Birth fracture: • It is a fracture in the new born children due to injury during birth
- 32. History of Fracture Classification • 18th & 19th century – History based on clinical appearance of limb alone Colles Fracture Dinner Fork Deformity
- 33. Salter-Harris Classification • Only used for pediatric fractures that involve the growth plate (physis) • Five types (I-V)
- 34. Salter-Harris type I fracture • Type I fracture is when there is a fracture across the physis with no metaphysial or epiphysial injury
- 35. Salter-Harris type II fracture • Type II fracture is when there is a fracture across the physis which extends into the metaphysis
- 36. Salter-Harris type III fracture • Type III fracture is when there is a fracture across the physis which extends into the epiphysis
- 37. Salter-Harris type IV fracture • Type IV fracture is when there is a fracture through metaphysis, physis, an d epiphysis
- 38. Salter-Harris type V fracture • Type V fracture is when there is a crush injury to the physis
- 39. What about CT scans & MRI ? • CT scanning can assist with fracture classification • Example: Sanders classification of calcaneal fractures
- 40. What is Dislocation? Joints Dislocation Is the total displacement of the articular end of a bone from the joint cavity. Subluxation : Is an incomplete displacement. Reduction : Is the restoration of the normal alignment of the bones. Classification: Dislocations are classified as follows: A. Congenital B. Traumatic C. Pathological D. Paralytic
- 41. PIP Joint Subluxation Elbow joint Dislocation. Dislocation & Subluxation (Sample Radiographs)
- 42. Thank You!