5. INTRODUCTION
STATEMENT OF SURGICAL IMPORTANCE
• Aetiology and classification of fractures helps
to determine the management and to avoid
complications
• It is therefore important as orthopaedic
surgeons to have this knowledge for better
outcome of patient care
6. INTRODUCTION
HISTORICAL BACKGROUND
• Ancient Egypt(1501BC)
– The Edwin Smith Papyrus classified injuries as:
– “An ailment which I will treat”
– “An ailment with which I will contend”
– “An ailment not to be treated”
• 18thand 19thCentury
-Descriptive classifications based on appearance of
limb
“Dinner Fork Deformity”
7. INTRODUCTION
HISTORICAL BACKGROUND
• 20thCentury
– The advent of radiographs
created numerous classification
systems
– Brought about the ability to identify
location, amount, and displacement
of fracture lines
– Not without problems as
radiographic views and quality can
be inconsistent
11. AETIOLOGY
MECHANISM
• Twisting causes a spiral fracture.
• Compression causes a short oblique fracture.
• Bending results in a fracture with a triangular
‘butterfly’
fragment.
• Tension tends to break the bone transversely;
13. CLASSIFICATION OF FRACTURES
• What makes a good classification?
• Inter-observer Reliability
• Do different physicians agree on the classification
of a particular fracture?
• Intra-observer Reproducibility
• For a given fracture, does the same physician
classify it the same way at different times?
14. CLASSIFICATION OF FRACTURES
GENERAL
• Based on communication
of fracture haematoma
with exterior
-Open
-Closed
• Based on the fracture
pattern
-Spiral
-Oblique
-Transverse
-comminuted
-Segmental
16. CLASSIFICATION OF FRACTURES
GENERAL- AO/OTA CLASSIFICATION
• Alphanumeric classification that can be
applied throughout the skeleton, based on
fracture location and morphology
• Created in the 1960’s and multiply updated to
include classifications of the pelvis and
acetabulum
23. GENERAL- Soft Tissue-Based
Classifications
• Gustilo-Anderson Classification
• Type I: wound≤1 cm, minimal contamination or muscle damage
• Type II: wound 1-10 cm, moderate soft tissue injury
• Type IIIA: wound usually >10 cm, high energy, extensive soft-tissue
damage, contaminated, but with adequate tissue for flapcoverage
• Type IIIB: extensive periosteal stripping, woundrequires soft tissue
coverage (rotational or free flap)
• Type IIIC: vascular injury requiringvascular repair,regardless of
degree of soft tissue injury
26. EPONYMOUS CLASSIFICATION
• Neer’s classification
• Based on anatomic segments of the proximal humerus
• Considered to be a ”part” if arbitrarily displaced 1 cm or angulated
45o
• Classification has good intraobserver reliability, but only moderate
interobserver reliability, though still useful for communication
purposes
51. REFERENCES
• Apley and Solomon’s System of Orthopaedics
and Trauma 10th ed
• Fracture and Dislocation Compendium—2018
A joint collaboration between the Orthopaedic
Trauma Association and the AO Foundation
