Classification of fractures in general

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fracture classifications in general orthopaedics

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Classification of fractures in general

  1. 1.  Define term the term fracture, dislocation and Subluxation  Identify the general causes, signs , symptoms of fractures  Classify the different types of fractures
  2. 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. 3.  Swelling or OEDEMA  pain and tenderness  Numbness  Bleeding  Broken skin with bone protruding Limitation to move a limb Signs and Symptoms
  4. 4. Why Classify? • As a treatment guide • To assist with prognosis • To speak a common language with other surgeons
  5. 5. 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
  6. 6. 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
  7. 7. To Speak A Common Language • This will allow results to be compared • PROBLEM: Poor interobserver reliability with existing fracture classifications
  8. 8. Intraobserver Reliability For a given fracture, each physician should produce the same classification
  9. 9. CLASSIFICATION • Based on Relationship with the environment • Based on Displacement • Based on Fracture pattern • Based on Etiology
  10. 10. CLASSIFICATION Based on relationship with the environment 1. CLOSED { Simple} 2. OPEN {Compound} – within _ without
  11. 11. 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!
  12. 12. Open Fractures • A break in the skin and underlying soft tissue leading to a communicating fracture hematoma
  13. 13. 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
  14. 14. CLASSIFICATION Based on Displacement 1. UNDISPLACED 2. DISPLACED – • Initial impact • Pull of surrounding muscles / gravity
  15. 15. 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
  16. 16. Displacement - Angulation • Angulation is the amount of bend at a fracture described in degrees. Described with respect to the apex of the angle .
  17. 17. Displacement - Shortening • Shortening is the amount a fracture is collapsed/ shifted proximally, expressed in centimeters.
  18. 18. CLASSIFICATION Based on fracture pattern 1. Transverse 2. Oblique 3. Spiral 4. Comminuted 5. Segmental 6. Stellate
  19. 19. 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
  20. 20. 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
  21. 21. 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.
  22. 22. CLASSIFICATION Based on etiology 1. TRAUMATIC 2. PATHOLOGICAL
  23. 23. CLASSIFICATION PATHOLOGICAL • --- Tumors • --- Bone cysts • --- Osteomyelitis • --- Osteoporosis • --- Osteogenesis imperfecta • --- Rickets etc
  24. 24. AO/OTA Classification • Describing the fracture localization: bones and segments • 1Humerus • 2Radius/ulna • 3Femur • 4Tibia/fibula
  25. 25. 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
  26. 26. 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
  27. 27. 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.
  28. 28. 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
  29. 29. • 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
  30. 30. History of Fracture Classification • 18th & 19th century – History based on clinical appearance of limb alone Colles Fracture Dinner Fork Deformity
  31. 31. Salter-Harris Classification • Only used for pediatric fractures that involve the growth plate (physis) • Five types (I-V)
  32. 32. Salter-Harris type I fracture • Type I fracture is when there is a fracture across the physis with no metaphysial or epiphysial injury
  33. 33. Salter-Harris type II fracture • Type II fracture is when there is a fracture across the physis which extends into the metaphysis
  34. 34. Salter-Harris type III fracture • Type III fracture is when there is a fracture across the physis which extends into the epiphysis
  35. 35. Salter-Harris type IV fracture • Type IV fracture is when there is a fracture through metaphysis, physis, an d epiphysis
  36. 36. Salter-Harris type V fracture • Type V fracture is when there is a crush injury to the physis
  37. 37. What about CT scans & MRI ? • CT scanning can assist with fracture classification • Example: Sanders classification of calcaneal fractures
  38. 38. 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
  39. 39. PIP Joint Subluxation Elbow joint Dislocation. Dislocation & Subluxation (Sample Radiographs)
  40. 40. Thank You!

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