concise on commonly followed important fracture classification system.

1. Fracture classification
Kshitiz Gyanwali
FCPS resident of orthopedics surgery
B&B Hospital

2. Objectives:
1. Basic principles of fracture classification
2. Fracture classification on the various basis
3. Commonly used classification system for specific fractures
4. Conclusion

3. Definition of fracture:
 A fracture is a break in the continuity of a bone.
 It can be classified on the basis of:
- Etiology
- Relationship with external environment
- Fracture morphology
- Site of fracture
- According to displacement.

4. Why classify the fractures?
1. To assist treatment guide
2. To prognosticate the pathology
3. To speak a universal common language

5. Classification of fractures:
1. On the basis of etiology:
A. Traumatic fractures:
- a normal bone fractures due to trauma sustained
B. pathological fractures:
- fracture of the bone in the area which is weakened by some underlying
disease process.

6. 2. On the basis of relation with external
environment:
A. Open fractures:
- fracture with break in the overlying skin and soft tissue.
- when fracture or fracture hematoma communicates with the external
environment, the fracture is called as Open.
B. Closed fractures:
- fracture does not communicate with the external environment.

7. 3. On the basis of fracture morphology:
1. Transverse fracture
2. Oblique fracture
3. Spiral fracture
4. Comminuted fracture
5. Segmental fracture

8. 4. On the basis of fracture site:
1. Epiphyseal fractures
2. Metaphyseal fractures
3. Diaphyseal fractures
a. proximal third
b. middle third
c. distal third
d. junctional factures

9. 5. On the basis of displacement:
1. Displaced fracture
2. Undisplaced fracture

10. ICRC classification of war wounds:
 Formulated in 1849 AD
 Surgeons who treated war wounded victims felt difficult to classify the nature
of wounds.
 This classification is based on the feature of wound itself but not on weapons
or presumed velocity of missiles.

11. ICRC parameters for wound score:

12. Example with scoring:

14. Limitations:
1. Observer error
2. Poor accuracy

15. AO classification of fractures:
• This classification system encompasses all types of fracture.
• Difficult to memorize but effective in research purposes.
• Results are expressed as alpha numeric coding which is suitable for computer
sorting(research purposes)
 Limitations:
• Discuss only about the fracture and not the dislocations
• Because of format it is not descriptive in verbal sense(not suitable for
conveying information about fracture)

16. AO classification system:
general concept
 The first number relates to the bone:
(Humerus is 1, Radius and Ulna are 2, Femur is 3 and tibia and
Fibula are 4)
 The second number relates to the position of the fracture on the bone
(1 is proximal, 2 diaphyseal, 3 is distal and 4 is malleolar)

17.  The position number is followed by a letter which defines severity of the
fracture.
A. For proximal and distal fractures (type 1 and 3):
- 'A' is extra-articular
-‘B' is partial articular
- C' is intraarticular.
B. For diaphyseal fractures (type 2):
- 'A' is a simple fracture
- 'B' is a wedge or butterfly type
- 'C' is comminuted fracture.

18. More detailed classification model:

19. Coding the fracture with AO system:
“32-A2”
 Simple oblique fracture of proximal shaft of femur.

20. Classification of open fractures:
(Gustilo and Anderson)
 Is a well established and commonly used classification system.
 Is a practical classification which relates well with pattern of injury and its
prognosis.
 3 types are described, the 3rd one being sub divided to allow more precise
grading.

22. Basic characteristics of this
classification:

23. Closed fracture classification(tscherne):
1. Grade 0: injuries have negligible soft tissue injury.
2. Grade 1: injuries have superficial abrasions or contusions of soft tissue
overlying the fracture
3. Grade 2: significant contusion of muscle, contaminated skin abrasion or both.
- bony injury is usually severe
4. Grade 3: excessive skin contusion, destruction of muscles, subcutaneous degloving,
acute compartment syndrome with rupture of major vessels or nerves

24. Pediatric fracture classification:
A. On the basis of fracture morphology:
1.transverse 1. Plastic bending
2. Oblique 2. Torus
3. Spiral 3. Green stick
4. Comminuted
5. Segmental

25. Salter and Harris classification of
epiphyseal injuries:

26. Some important fracture classifications:
A. UPPER LIMB
1.

27. 2. Neer’s classification for fracture of
proximal humerus:

28. 3. Gartland’s classification of pediatric
supracondylar fracture:

29. 4. Frykmann’s distal radius fracture
classification:

30. B. Fracture classification of lower limb:
1.Tile’s classification for pelvis fracture:

31. Tile’s classification for pelvis fracture:

32. 2. Letournel and Judet acetabular
fracture classification:

33. 3.Garden’s classification of Fracture
neck of femur:
1. Garden stage 1 - fracture is incomplete,
This is an impacted fracture.
2. Garden stage 2- fractures are complete but
undisplaced
3. Garden stage 3 - fractures are complete and
partially displaced, but the two fragments remain in
contact with each other.
4. Garden stage 4 - fracture fragments are completely
displaced and rotated

34. 4. Evan’s intertrochanteric fracture
classification:

35. 5. Schatzer’s classification of tibial
plateau fracture:
1. Type I:
- split fracture of lateral tibial plateau without
articular depression.
2. Type II:
- split depressed fracture of lateral tibial plateau
3. Type III:
- isolated depression of lateral plateau
- can involve any part of articular surface but mostly
central

36. Contd..
4. Type IV:
-fracture of medial plateau
5. Type V:
-bicondylar plateau fracture with varying degree of
articular depression and displacement of condyles.
6. Type VI:
- bicondylar tibial plateau fracture with diaphyseal
and metaphyseal dissociation

38. 6. Lauge-Hansen classification of ankle
fractures
Pronation external
rotation
Pronation
abduction
Supination
adduction
Supination external
rotation

39. C. TLICS classification of spine fracture:

40. Contd..

41. Conclusion:
 Fracture classification being a universal coding system, has helped for global
understanding about the disease.
 Helps to plan for management of specific factures.
 Prognosis of the fracture and preoperative counselling regarding morbidity
and mortality to patients has become much easy with classification system.
 Improvising the old and giving new classification model is a continuous
process which increases the accuracy of outcome.

42. References: