Classification of fracture

2. CLASSIFICATION
 Based on Relationship with the Environment
 Based on Displacement
 Based on Fracture Pattern
 Based on Etiology
 Based on Complexity of treatment
 Based on Force causing fracture

3. CLASSIFICATION BASED ON
RELATIONSHIP WITH ENVIRONMENT
1.Closed fracture: no communication with external
envt; overlying tissue and skin are intact.
2.Open fracture :communication with ext envt
present; break in overlying soft tissue and skin.

4. Open Fractures
 Fracture with break in overlying
skin and soft tissues
 Fracture communicates with the
external environment
1. Internally open(from within):sharp
fracture end pierces skin from
within
2. Externally open(open from
outside):object causing fracture
lacerates the skin and soft tissues
over the bone as it breaks the bone

5. Gustillo Classification
 The Gustillo classification is used to classify open
fractures.
 Three grades that try to quantify the amount of soft
tissue damage associated with the fracture
Grade 1 — <1cm wound, minimum soft t/s injury
Grade 2 — >1cm wound, moderate soft t/s injury
Grade 3 — >10cm wound, severe muscle devitalization
Grade 3 has subgrades A, B ,C.

6. GUSTILO CLASSIFICATION

7. Grade 3A
 Limited stripping of periosteum and soft tissue
from bone.
 Adequate soft tissue coverage for bone, tendons
and neurovascular bundle.

8. Grade 3B
 Extensive stripping of soft tissue and periosteum
from bone.
 Requires a local flap or free tissue transfer
Grade 3C
 A major vascular injury requiring repair

9. Muller’s Classification
 Each long bone has 3 segments
Proximal, Diaphyseal and Distal
 Diaphyseal Fractures:
 Simple
 Wedge
 Complex
 Proximal & Distal
 Extra-Articular
 Partial Articular
 Complete Articular

10. Classification: Based on
Displacement
1. UNDISPLACED
2. DISPLACED

11. Displaced fracture
 A fracture may be displaced
 Factors responsible for displacement
1. The fracturing force
2. Muscle pull on fracture fragments
3. gravity

12. 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

13. Displacement - Angulation
 Angulation is the
amount of bend at a
fracture described in
degrees.
Described with
respect to the apex of
the angle .

14. Displacement - Shortening
 Shortening is the
amount a fracture is
collapsed/ shifted
proximally,
expressed in
centimeters.

15. Classification: Based on
Pattern
1. Transverse
2. Oblique
3. Spiral
4. Comminuted
5. Segmental
6. Stellate

16. Transverse Fracture
A fracture in which fracture
line is perpendicular to the
long axis of the bone . Caused
by bending or tapping force.
Oblique Fracture
A fracture in which the fracture
line is at oblique angle to the long
axis of the bone. Caused by
bending force.
According to the Path of Fracture Line

17. Spiral Fracture :-
A severe form of oblique fracture in
which the fracture line runs spirally in
more than one plane.These fractures
occur primarily to a twisting force.
According to the Path of fracture Line

18. Anatomical Classification of Fractures
Comminuted Fracture :
The bone is broken into many
fragments. Caused by
crushing or compressed
force.
Segmental Fracture:
In this type of fracture , there are
two types of fractures in one
bone, but at different levels.

19. Anatomical Classification of Fractures
Impacted Fracture:
This fracture where a vertical
force drives the distal fragment
of the fracture into the proximal
fragment.
Depressed Fracture:
This fracture occurs in the
skull where a segment of
bone gets depressed into the
cranium.

20. Avulsion Fracture:
A chip of bone is avulsed by the sudden and unexpected
contraction of a powerful muscle from its point of insertion,
Examples:-
1. Anterior superior iliac spine avulsion.
2. JONE’S 5th metatarsal base avulsion.
Anatomical Classification of Fractures

21. 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
Anatomical Classification of Fractures

22. Classification: Based on Etiology
1. TRAUMATIC
2. PATHOLOGICAL
 Tumors(metastasis)
 Bone cysts
 Osteomyelitis
 Osteoporosis
 Osteogenesis imperfecta (Brittle bone d/s)
 Rickets

23. Salter-Harris Classification
 Only used for pediatric fractures that involve
the growth plate (physis)

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

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

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

27. Salter-Harris type IV fracture
 Type IV fracture is
when there is a
fracture through
metaphysis, physis,
and epiphysis

28. Salter-Harris type V
fracture
 TypeV fracture is
when there is a crush
injury to the physis

29. Based on complexity of
treatment
 Simple :fracture in
two pieces usually
easy to treat.eg;
transverse fracture
of humerus
 Complex: fracture in
multiple pieces usually
difficult to
treat.eg;comminuted
fracture of tibia

30. Based on force causing fracture
 High velocity injury:
fractures sustained
due to trauma, soft
tissue injury.There is
extensive
devascularisation. It
is slow to heal.
 Low velocity injury:
fractures due to a
fall,little soft tissue
injury , fracture heals
predictably.

31. FRACTURE WITH EPONYMS
1. MONTEGGIA FRACTURE DISLOCATION
:fracture of proximal third of ulna ,with
dislocation of head of radius.
2. GALEAZZI FRACTURE DISLOCATION:fracture
of distal third of radius with dislocation of distal
radio ulnar joint
3. COLLE’S FRACTURE:A fracture occuring in
adults at the cortico cancellous junction at the
distal end of radius with central tilt and other
displacements.