This document outlines the aetiology, classifications, and complications of fractures. It begins with definitions and historical background on fracture classifications. Key points include that fractures are caused by injury or repetitive stress and can be complete or incomplete. Several classification systems are described, including the AO/OTA system which categorizes fractures based on location and morphology. Eponymous classifications like Neer for proximal humerus fractures and Schatzker for tibial plateau fractures are also covered. Management depends on the classification and may involve operative or non-operative treatment. Classifications are important for communication, guidelines, and prognosis.

1. FRACTURE: AETIOLOGY,
CLASSIFICATIONS AND
COMPLICATIONS
DR FADAMIJO J S
NOH IGBOBI, LAGOS

2. OUTLINE
• INTRODUCTION
-Definition
-Statement of surgical importance
-Historical background
• RELEVANT ANATOMY
• AETIOLOGY
• TYPES OF FRACTURES

3. OUTLINE
• CLASSIFICATION OF FRACTURES
-General
-Eponymous
• MANAGEMENT
• COMPLICATIONS
• CONCLUSION
• REFERENCES

4. INTRODUCTION
DEFINITION
• A fracture is a break in the structural
continuity of bone

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

8. INTRODUCTION
HISTORICAL BACKGROUND
• The last 40 Years
• CT has allowed for further understanding and
classification of intra-articular fractures

9. RELEVANT ANATOMY

10. AETIOLOGY
• Injury
-Direct
-Indirect
• Repetitive stress
• Abnormal weakening of the bone (a
pathological fracture)

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;

12. TYPES OF FRACTURES
• Complete
• Incomplete

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

15. GENERAL
• Based on
displacement
-Non-displaced
-Displaced
• Based on extension
to joint
-Extra-articular
-Intra-articular
CLASSIFICATION OF FRACTURES

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

17. GENERAL- AO/OTA CLASSIFICATION
• Fracture
Location
• Which bone?
• Each bone is
assigned a specific
number
• 1-9

18. GENERAL- AO/OTA CLASSIFICATION
• Fracture Location
• Which part of the
bone?
1. Proximal end segment
2. Diaphyseal segment
3. Distal end segment

19. GENERAL- AO/OTA CLASSIFICATION
Fracture Morphology
Diaphyseal segment
• Type A: Simple fractures
• spiral, oblique, transverse
• Type B: Wedge fractures
• spiral, bending, fragmented
• Type C: Multifragmentary fractures
• spiral wedge, segmented, irregular

20. GENERAL- AO/OTA CLASSIFICATION
• Fracture Morphology
– End segmentType A:
Extra-articular
– Type B: Partial articular
– Type C: Complete articular

21. GENERAL- Soft Tissue-Based
Classifications
• Oesterne and Tscherne
Classification
• Gustilo-Anderson
Classification
• OTA Open Fracture
Classification

22. GENERAL- Soft Tissue-Based
Classifications

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

24. GENERAL- Soft Tissue-Based
Classifications

25. EPONYMOUS CLASSIFICATION

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

27. EPONYMOUS CLASSIFICATION
• Gartland classification

28. EPONYMOUS CLASSIFICATION

29. EPONYMOUS CLASSIFICATION
• Mayo’s
Classification of
Olecranon
fractures

30. EPONYMOUS CLASSIFICATION
Colles’ vs Smith’s

31. EPONYMOUS CLASSIFICATION
• Frykman’s
classification

33. EPONYMOUS CLASSIFICATION
• Judet and
Letournel
classification

34. • Tile
classification

35. EPONYMOUS CLASSIFICATION

36. EPONYMOUS CLASSIFICATION

37. EPONYMOUS CLASSIFICATION

38. EPONYMOUS CLASSIFICATION
• Kyle classification of inter-tronchanteric
fractures

39. EPONYMOUS CLASSIFICATION
• Seinsheimer
classification
of sub-
tronchanteric
fractures

40. EPONYMOUS CLASSIFICATION
• Winquist classification of femoral shaft
fractures

41. EPONYMOUS CLASSIFICATION
• Schatzker classification
of tibial plateau
fractures

42. EPONYMOUS CLASSIFICATION
• Danis-Weber classification of ankle fractures
A B C

43. EPONYMOUS CLASSIFICATION
• Lauge-Hansen
classification
• Based on
direction of
force at the
time of injury

44. EPONYMOUS CLASSIFICATION
• Pilon fractures
I II III

45. EPONYMOUS CLASSIFICATION
• Hawkin’s
classification
of the talar
fractures

46. EPONYMOUS CLASSIFICATION
• Sander’s classification of calcaneal fractures

47. MANAGEMENT
• ATLS protocol
• Definitive care: depends on class and
aetiology
• Operative vs non-operative

50. CONCLUSION
• Classifications are essential for
communication, education, treatment
guidelines, and as a prognostic tool

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