Fracture Description Classification Regions Emergency Medicine Anatomic description

Fracture Description & Classification Regions Emergency Medicine

Anatomic description of fractures n Type n Comminution n Location n Displacement

Anatomic description - Type is the overall fracture pattern n Examples are: n – Simple – Spiral – segmental

Anatomic description Communition n Comminution is the measure of the number of pieces of broken bone that there are. n Examples are: non-comminuted or mildly comminuted or severely comminuted

Anatomic description - Location n Location is the anatomic location of the fracture usually described by giving the bone involved and location on the bone n Examples are: distal radial shaft, proximal 1/3 humeral shaft, intraarticular distal tibial

Anatomic description Displacement is the amount the pieces of a fracture have moved from their normal location n Can be displaced or non-displaced n Subdivided into 3 sub-categories: translation, angulation, and shortening

Displacement - Translation n Translation is sideways motion of the fracture - usually described as a percentage of movement when compared to the diameter of the bone.

Displacement - Angulation n 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 n Shortening is the amount a fracture is collapsed expressed in centimeters. Sometimes called bayonette apposition.

Anatomic description?

Anatomic description n Simple, transverse, non-communited midshaft radial and ulnar fracture with 30 degrees apex radial angulation.

Anatomic description? ?

Anatomic description n 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? n Classification or description of fractures is only used when the classification or description is useful in providing treatment or outcomes

Types of classifications n Anatomic description n AO classification n Salter-Harris classification n Gustillo open fracture classification n Fracture specific classifications

AO Classification

AO Classification 1 st number = long bone n 2 nd number = bone segment n Letter = fracture type (A, B, C) n Then 3 rd & 4 th numbers classify fracture group & subgroup n

Salter-Harris Classification n Only used for pediatric fractures that involve the growth plate (physis) n Five types (I-V)

Salter-Harris type I fracture n Type I fracture is when there is a fracture across the physis with no metaphysial or epiphysial injury

Salter-Harris type II fracture n Type II fracture is when there is a fracture across the physis which extends into the metaphysis

Salter-Harris type III fracture n Type III fracture is when there is a fracture across the physis which extends into the epiphysis

Salter-Harris type IV fracture n Type IV fracture is when there is a fracture through metaphysis, and epiphysis

Salter-Harris type V fracture n Type V fracture is when there is a crush injury to the physis

Gustillo classification n The Gustillo classification is used to classify open fracture - ones in which the skin has been disrupted n Three grades that try to quantify the amount of soft tissue damage associated with the fracture

Open fractures - grade 1 n wound less than 1 cm w/ minimal soft tissue injury n wound bed is clean n bone injury is simple w/ minimal comminution n w/ IM nailing, average time to union is 21 -28 weeks

Open fractures - grade 2 n wound is greater than 1 cm w/ moderate soft tissue injury n wound bed is moderately contaminated n fracture contains moderate comminution n w/ IM nailing, average time to union is 26 -28 weeks

Open fractures - grade 3 A n wound greater than 10 cm w/ crushed tissue and contamination n soft tissue coverage of bone is usually possible n w/ IM nailing, average time to union is 30 -35 weeks

Open fractures - grade 3 B n wound greater than 10 cm w/ crushed tissue and contamination n soft tissue is inadequate and requires regional or free flap n w/ IM nailing, average time to union is 30 -35 weeks

Open fractures - grade 3 C n is fracture in which there is a major vascular injury requiring repair for limb salvage n fractures can be classified using the MESS n in some cases it will be necessary to consider BKA following tibial fracture

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