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ORTHO ANDALAS NOTES @orthopaedi_unand ORTHOPAEDI & TRAUMATOLOGI FAKULTAS KEDOKTERAN UNAND
FRACTURE CLASSIFICATIONS FRACTURE CLASSIFICATION ORTHO ANDALAS NOTES
FRACTURE CLASSIFICATIONS TABLE OF CONTENT : 1. UPPER LIMB 2. AXIAL 3. LOWER LIMB ORTHO ANDALAS NOTES
UPPER LIMB FRACTURE CLASSIFICATION ORTHO ANDALAS NOTES 1. Scapula 2. Acromial 3. Coracoid 4. Clavicle 5. Proximal humerus 6. Shaft humerus 7. Supracondylar humerus 8. Distal humerus 9. Radial head 10. Proximal ulnar 11. Radial shaft 12. Ulna shaft 13. Distal radius 14. Scaphoid 15. Metacarpal 16. Phalanges TABLE OF CONTENT
FRACTURE OF SCAPULA: ZDARKOVIC AND DAMHOLT (BASED ON ANATOMICAL LOCATION)  AO/OTA Fracture and Dislocation Classification The scapula is numbered bone 14 : process (14A), body (14B), and glenoid fossa (14F).  Anatomic Classification (Zdravkovic and Damholt) (Fig. 13.1)  Type I: Scapula body  Type II: Apophyseal fractures, including the acromion and coracoid  Type III: Fractures of the superolateral angle, including the scapular neck and glenoid ORTHO ANDALAS NOTES
IDEBERG CLASSIFICATION (BASED ON DISPLACEMENT OF THE ARTICULAR COMPONENT)  Ideberg Classification of Intra-Articular Glenoid Fractures  Type I: Avulsion fracture of the anterior margin  Type IIA: Transverse fracture through the glenoid fossa exiting inferiorly  Type IIB: Oblique fracture through the glenoid fossa exiting inferiorly  Type III: Oblique fracture through the glenoid exiting superiorly and often associated with an acromioclavicular joint injury  Type IV: Transverse fracture exiting through the medial border of the scapula  Type V: Combination of a type II and type IV pattern  Type VI: Comminuted glenoid fracture ORTHO ANDALAS NOTES
CLASSIFICATION OF ACROMIAL FRACTURES : KUHN ET AL (BASED ON DISPLACEMENT)  Type I: Minimally displaced  Type II: Displaced but does not reduce the subacromial space  Type III: Displaced with narrowing of the subacromial space ORTHO ANDALAS NOTES
CLASSIFICATION OF CORACOID FRACTURES: OGAWA (BASED ON LOCATION FROM CORACOCLAVICULAR LIGAMENT)  Type I: Proximal to the coracoclavicular ligament  Type II: Distal to the coracoclavicular ligament ORTHO ANDALAS NOTES
CLAVICLE FRACTURE AO/OTA Fracture and Dislocation Classification  15.1 (proximal [medial]), 15.2 (diaphyseal), and 15.3 (distal [lateral]).  The proximal (medial) and distal (lateral) end segments are divided into types A (extraarticular), B (partial articular), and C (complete articular).  The diaphyseal seg-ment is divided into types A (simple), B (wedge), and C (multifragmentary) ORTHO ANDALAS NOTES
 Group I: fracture of the middle third (80%). This is the most common fracture in both children and adults; proximal and distal segments are secured by ligamentous and muscular attachments.  Group II: fracture of the distal third (15%)  Group III: fracture of the proximal third (5%). Minimal displacement results if the costoclavicular ligaments remain intact. It may represent epiphyseal injury in children and teenagers ALLMAN CLASSIFICATION (BASED ON ANATOMICAL LOCATION) ORTHO ANDALAS NOTES
Type 1 is a fracture lateral to the coracoclavicular ligament, in which the conoid and trapezoid remain intact, with minimal displacement. Type 2A is a fracture medial to the coracoclavicular ligament, in which the conoid and trapezoid remain intact, with medial clavicle displacement. Type 2B is a fracture that occurs between or lateral to the coracoclavicular ligaments, in which the conoid is torn and the trapezoid may be intact, with medial clavicle displacement. Type 3 is an intra-articular fracture, in which the conoid and trapezoid remain intact, with minimal displacement. Type 4 is a physeal fracture in an immature skeleton, in which the conoid and trapezoid remain intact, with lateral clavicle displacement. Type 5 is a comminuted fracture, in which the conoid and trapezoid remain intact, with medial clavicle displacement. 1 AC, acromioclavicular. NEER CLASIFICATION (BASED ON THE RELATIONSHIP BETWEEN FRACTURES AND THE CORACOCLAVICULAR LIGAMENTS) ORTHO ANDALAS NOTES
ACROMIOCLAVICULAR JOINT INJURY ORTHO ANDALAS NOTES
ORTHO ANDALAS NOTES
PROXIMAL HUMERUS FRACTURE AO/OTA Fracture and Dislocation Classification ORTHO ANDALAS NOTES
• One-part fractures: Nodisplaced fragments regardless of number of fracture lines • Two-part fractures (any of the following): • Anatomic neck • Surgical neck • Greater tuberosity • Lesser tuberosity • Three-part fractures: • Surgical neck with greater tuberosity • Surgical neck with lesser tuberosity • Four-part fractures • Fracture-dislocation • Articularsurfacefracture NEER CLASSIFICATION (BASED ON PART A FRAGMENT OF FRACTURE) ORTHO ANDALAS NOTES
SHAFT HUMERUS FRACTURE (BASED ON PATTERN OF FRACTURE) AO/OTA Fracture and Dislocation Classification ORTHO ANDALAS NOTES
SUPRACONDYLAR HUMERUS FRACTURE : GARTLAND (BASED ONTHE DEGREE OF DISPLACEMENT) 1. Extension Type  This represents 98% of supracondylar humerus fractures in children. This is based on the degree of displacement.  Type I: Nondisplaced  Type II: Displaced with intact posterior cortex; may be angulated or rotated  Type III: Complete displacement; posteromedial or posterolateral 2. Flexion Type  This comprises 2% of supracondylar humerus fractures in children.  Type I: Nondisplaced  Type II: Displaced with intact anterior cortex  Type III: Complete displacement; usually anterolateral ORTHO ANDALAS NOTES
DISTAL HUMERUS FRACTURE (BASED ON ARTICULAR INVOLVEMENT) AO/OTA Fracture and Dislocation Classification ORTHO ANDALAS NOTES
INTERCONDYLAR FRACTURE OF HUMERUS (BASED ONTHE DEGREE OF DISPLACEMENT)  Riseborough and Radin  Type I: Nondisplaced  Type II: Slight displacement with no rotation between the condylar fragments  Type III: Displacement with rotation  Type IV: Severe comminution of the articular surface ORTHO ANDALAS NOTES
LATERAL AND MEDIAL CONDYLE FRACTURE OF HUMERUS (BASED ON LOCATION OF THE COMMON FRACTURE LINES)  MILCH  Type I: Lateral trochlear ridge left intact  Type II: Lateral trochlear ridge part of the condylar fragment (medial or lateral) ORTHO ANDALAS NOTES
RADIAL HEAD FRACTURE AO/OTA Fracture and Dislocation Classification ORTHO ANDALAS NOTES
MASON (BASED ON DEGREE OF DISPLACEMENT AND DISLOCATION)  Type I: Nondisplaced fractures  Type II: Marginal fractures with displacement (impaction, depression, angulation)  Type III: Comminuted fractures involving the entire head  Type IV: Associated with dislocation of the elbow (Johnston) ORTHO ANDALAS NOTES
PROXIMAL ULNA FRACTURE AO/OTA Fracture and Dislocation Classification ORTHO ANDALAS NOTES
MAYO (BASED ON DISPLACEMENT, COMMINUTION,AND SUBLUXATION OR DISLOCATION) • Type I : fractures are nondisplaced or minimally displaced and are subclassified as either noncomminuted (type 1A) or comminuted (type 1B). • Type II : fractures have displacement of the proximal fragment without elbow instability • Type II A: fractures which are noncomminuted • TypeIIB : fractures are comminuted • Type III : fractures feature instability of the ulnohumeral joint and require surgical treatment. ORTHO ANDALAS NOTES
SCHATZKER (BASED ON FRACTURE PATTERN) • Transverse: Occurs at the apex of the sigmoid notch and represents an avulsion fracture from a sudden, violent pull of both triceps and brachialis and uncommonly from direct trauma. • Transverse-impacted: A direct force leads to comminution and depression of the articular surface. • Oblique: Results from hyperextension injury; it begins at midpoint of the sigmoid notch and runs distally. • Comminuted fractures with associated injuries: Result from direct high energy trauma ; fractures of the coronoid process may lead to instability. • Oblique-distal : Fracture extends distal to the coronoid and compromises elbow stability. • Fracture-dislocation: Usually associated with severe trauma. ORTHO ANDALAS NOTES
GALEAZZI FRACTURE OR RADIAL SHAFT FRACTURE (BASED ON FRACTURE PATTERN) • AO/OTA Fracture and Dislocation Classification ORTHO ANDALAS NOTES
ULNA SHAFT FRACTURE AND MONTEGGIA FRACTURE  AO/OTA Fracture and Dislocation Classification ORTHO ANDALAS NOTES
 Type I: Anterior dislocation of the radial head with fracture of ulnar diaphysis at any level with anterior angulation  Type II: Posterior/posterolateral dislocation of the radial head with fracture of ulnar diaphysis with posterior angulation  Type III: Lateral/anterolateral dislocation of the radial head with fracture of ulnar metaphysis  Type IV: Anterior dislocation of the radial head with fractures of both radius and ulna within proximal third at the same level BADOO CLASSIFICATION OF MONTEGGIA (BASED ON DISLOCATION OF RADIAL HEAD) ORTHO ANDALAS NOTES
DISTAL RADIUS FRACTURE (BASED ON FRACTURE PATTERN) AO/OTA Fracture and Dislocation Classification ORTHO ANDALAS NOTES
FRYKMAN CLASSIFICATION (BASED ON THE PATTERN OF INTRA-ARTICULAR INVOLVEMENT) ORTHO ANDALAS NOTES
• Type I: Metaphyseal bending fracture with the inherent problems of loss of palmar tilt and radial shortening relative to the ulna (DRUJ injury) • Type II: Shearing fracture requiring reduction and often buttressing of the articular segment • Type III: Compression of the articular surface without the characteristic fragmentation; also the potential for significant interosseous ligament injury • Type IV: Avulsion fracture or radiocarpal fracture-dislocation • Type V: Combined injury with significant soft tissue involvement owing to high-energy injury FERNANDEZ CLASSIFICATION (BASED ON MECHANISM) ORTHO ANDALAS NOTES
ORTHO ANDALAS NOTES
SCAPHOID FRACTURE (BASED ON LOCATION OF FRACTURE LINE) Mayo classification (based on location of fracture line)  Type I : Distal tubercle fracture  Type II : Distal articular surface fracture  Type III : Distal third fracture  Type IV : Middle third fracture  TypeV : Proximal third fracture ORTHO ANDALAS NOTES
BANNET FRACTURE ORTHO ANDALAS NOTES
ROLANDO FRACTURE ORTHO ANDALAS NOTES
METACARPAL FRACTURE ORTHO ANDALAS NOTES
PHALANG FRACTURE ORTHO ANDALAS NOTES
AXIAL FRACTURE CLASSIFICATION ORTHO ANDALAS NOTES 1. Occipital condyle 2. Atlas 3. Odontoid process 4. Traumatic spondilolystesis 5. Compression 6. Distractive flexion 7. Compressive extension 8. Distractive extension 9. Lateral flexion 10. Clay’s Shoveler 11. Thoracolumbar 12. Burst fracture 13. Flexion-distraction injury TABLE OF CONTENT
OCCIPITAL CONDYLE FRACTURES  Type I: Impaction of condyle; usually stable  Type II: Shear injury associated with basilar or skull fractures; potentially unstable  Type III: Condylar avulsion; unstable ORTHO ANDALAS NOTES
ATLAS FRACTURES : LEVINE 1. Isolated bony apophysis fracture 2. Isolated posterior arch fracture 3. Isolated anterior arch fracture 4. Comminuted lateral mass fracture 5. Burst fracture, also known as the Jefferson fracture ORTHO ANDALAS NOTES
FRACTURES OF THE ODONTOID PROCESS (DENS) : ANDERSON AND D’ALONZO  Type I: Oblique avulsion fracture of the apex (5%)  Type II: Fracture at the junction of the body and the neck; high nonunion rate, which can lead to myelopathy (60%)  Type III: Fracture extending into the cancellous body of C2 and possibly involving the lateral facets (30%) ORTHO ANDALAS NOTES
TRAUMATIC SPONDYLOLISTHESIS OF C2 (HANGMAN’S FRACTURE): LEVINE AND EDWARDS  Type I: Nondisplaced, no angulation; translation <3 mm; C2–C3 disc intact (29%); relatively stable  Type IA: Atypical unstable lateral bending fractures that are obliquely displaced and usually involve only one pars interarticularis, extending anterior to the pars and into the body on the contralateral side  Type II: Significant angulation at C2–C3; translation >3 mm; most common injury pattern; unstable; C2–C3 disc disrupted (56%); subclassified into flexion, extension, and olisthetic types  Type IIA: Avulsion of entire C2–C3 intervertebral disc in flexion with injury to posterior longitudinal ligament, leaving the anterior longitudinal ligament intact; results in severe angulation; no translation; unstable; probably caused by flexion-distraction injury (6%); traction contraindicated  Type III: Rare; results from initial anterior facet dislocation of C2 on C3 followed by extension injury fracturing the neural arch; results in severe angulation and translation with unilateral or bilateral facet dislocation of C2–C3; unstable (9%); type III injuries most commonly associated with spinal cord injury; frank dislocation; extremely rare ORTHO ANDALAS NOTES
INJURIES TO C3–C7 CLASSIFICATION (ALLEN-FERGUSON) COMPRESSIVE FLEXION (SHEAR MECHANISM RESULTING IN “TEARDROP” FRACTURES) ORTHO ANDALAS NOTES
VERTICAL COMPRESSION (BURST FRACTURES) ORTHO ANDALAS NOTES
DISTRACTIVE FLEXION (DISLOCATIONS) ORTHO ANDALAS NOTES
COMPRESSIVE EXTENSION ORTHO ANDALAS NOTES
DISTRACTIVE EXTENSION ORTHO ANDALAS NOTES
LATERAL FLEXION ORTHO ANDALAS NOTES
“CLAY SHOVELER’S” FRACTURE ORTHO ANDALAS NOTES
THORACOLUMBAR FRACTURE COMPRESSION FRACTURES (BASED ON END PLATE INVOLVEMENT ) ORTHO ANDALAS NOTES
BURST FRACTURES (BASED ON END PLATE INVOLVEMENT ) ORTHO ANDALAS NOTES
FLEXION–DISTRACTION INJURIES ORTHO ANDALAS NOTES
FRACTURE DISLOCATIONS (BASED ON MECHANISM OF INJURY) ORTHO ANDALAS NOTES
SPONDYLOLYSIS AND SPONDYLOLISTHESIS ORTHO ANDALAS NOTES
ORTHO ANDALAS NOTES
LOWER LIMB FRACTURE CLASSIFICATION ORTHO ANDALAS NOTES 1. Pelvic 2. Acetabular 3. Femoral head 4. Femoral neck 5. Intertrochanteric 6. Subtrochanteric 7. Periprosthetic hip 8. Femoral shaft 9. Diaphyseal Femur 10. Distal femur 11. Patella 12. Floating knee 13. Tibial plateau 14. Proximal tibia 15. Tibial shaft 16. Distal tibia TABLE OF CONTENT 17. Pilon Fracture 18. Ankle 19. Calcaneal 20. Tarsometatarsal 21. Metatarsal
PELVIC :YOUNG-BURGESS CLASSIFICATION (BASED ON INJURY MECHANISM) ORTHO ANDALAS NOTES
PELVIC :YOUNG-BURGESS CLASSIFICATION BASED ON INJURY MECHANISM. ORTHO ANDALAS NOTES
PELVIC :AO / OTA CLASSIFICATION. ORTHO ANDALAS NOTES
ACETABULAR : LETOURNEL CLASSIFICATION (BASED ON INVOLVEMENT OF ACETABULAR COLUMNS AND WALLS) The five elemental fracture types. a Posterior wall. b Posterior column. c Anterior wall. d Anterior column. E Transverse. ORTHO ANDALAS NOTES
ACETABULAR : LETOURNEL CLASSIFICATION BASED ON INVOLVEMENT OF ACETABULAR COLUMNS ANDWALLS The five associated fracture types. a Posterior column and wall. b Transverse and posterior wall. c T - t y p e . d Anterior column and posterior hemitransverse. e Both columns ORTHO ANDALAS NOTES
ACETABULAR :AO / OTA CLASSIFICATION 62A Pelvis, acetabulum, partial articular, isolated column and/or wall fracture 62B Pelvis, acetabulum, partial articular, transverse type fracture 62C Pelvis, acetabulum, complete articular, associated both column fracture ORTHO ANDALAS NOTES
FEMORAL HEAD: PIPKIN CLASSIFICATION (BASED ON LOCATION OF FRACTURE RELATIVE TO FOVEA AND PRESENCE OR ABSENCE OF ASSOCIATED FRACTURES OF THE ACETABULUM OR FEMORAL NECK) ORTHO ANDALAS NOTES
FEMORAL NECK: GARDEN CLASSIFICATION BASED ON ORIENTATION OFTRABECULAR LINES AND DISPLACEMENT ORTHO ANDALAS NOTES
FEMORAL NECK: PAUWELS CLASSIFICATION BASED ON ORIENTATION OF FRACTURE LINE ORTHO ANDALAS NOTES
INTERTROCHANTERIC : BOYD & GRIFFIN CLASSIFICATION BASED ONTHE INVOLVEMENT OF SUBTROCHANTERIC REGION Type I : Stable Type II : Unstsble comminuted Type III : Unxtable reverse oblique Type IV : Intertrochanteric ORTHO ANDALAS NOTES
SUBTROCHANTERIC : RUSSELL –TAYLOR CLASSIFICATION BASED ON INVOLVEMENT OF LESSERTROCHANTER AND PIRIFORMIS FOSSA ORTHO ANDALAS NOTES
AO / OTA CLASSIFICATION TROCHANTEERIC FEMUR 31A Femur, trochanteric fracture 31B Femur, neck fracture 31C Femur, head fracture ORTHO ANDALAS NOTES
THEVANCOUVER CLASSIFICATION OF PERIPROSTHETIC HIP FRACTURES Vancouver classification (intraoperative) • considerations • location • pattern • stability of fracture • types • A - proximal metaphysis • B - diaphyseal • C - distal to stem tip (not amenable to insertion of longest revision stem) • subtypes • 1 - cortical perforation • 2 - nondisplaced crack • 3 - displaced unstable fracture pattern ORTHO ANDALAS NOTES
FEMORAL SHAFT : BOYD & GRIFFIN CLASSIFICATION BASED ONTHE INVOLVEMENT OF SUBTROCHANTERIC REGION ORTHO ANDALAS NOTES
AO / OTA CLASSIFICATION DIAPHYSEAL FEMUR BASED ON FRACTURE PATTERN 32A Femur, diaphyseal segment, simple fracture 32B Femur, diaphyseal segment, wedge fracture 32C Femur, diaphyseal segment, multifragmentary fracture ORTHO ANDALAS NOTES
AO / OTA CLASSIFICATION DISTAL FEMUR BASED ON ARTICULAR INVOLVEMENT 33A Femur, distal end segment, extraarticular fracture 33B Femur, distal end segment, partial articular fracture 33C Femur, distal end segment, complete articular fracture ORTHO ANDALAS NOTES
AO / OTA CLASSIFICATION PATELLA BASED ON ARTICULAR INVOLVEMENT 34A Patella, extraarticular fracture 34B Patella, partial articular fracture 34C Patella, complete articular fracture, frontal/coronal plane ORTHO ANDALAS NOTES
AO / OTA CLASSIFICATION PATELLA • 34A1 Patella, extraarticular, avulsion fracture • 34B1 Patella, partial articular, sagittal, lateral fracture • 34B2 Patella, partial articular, sagittal, medial fracture • 34C1 Patella, complete articular, frontal/coronal, simple fracture • 34C2 Patella, complete articular, frontal/coronal, wedge fracture • 34C3 Patella, complete articular, frontal/coronal, multifragmentary fracture ORTHO ANDALAS NOTES
FRASER CLASSIFICATION (FLOATING KNEE) Fraser classification (floating knee) Type I: both fractures involve the shaft with articular involvement of the knee. Type II: articular involvement of the knee Type IIa: tibial plateau fractures Type IIb: intercondylar fractures (T orY fractures) of the inferior extremity of the femur Type IIc: both sites are articular ORTHO ANDALAS NOTES
TIBIAL PLATEAU FRACTURE : SKATZKER CLASSIFICATION BASED ON LOCATION AND DEPRESS FRACTURE • Schatzker I: wedge-shaped pure cleavage fracture of the lateral tibial plateau, originally defined as having less than 4 mm of depression or displacement • Schatzker II: splitting and depression of the lateral tibial plateau; namely, type I fracture with a depressed component (generally considered commonest 5 ) • Schatzker III: pure depression of the lateral tibial plateau; divided into two subtypes • Schatzker IIIa: with lateral depression • Schatzker IIIb: with central depression • Schatzker IV: medial tibial plateau fracture with a split or depressed component • Schatzker V: wedge fracture of both lateral and medial tibial plateau • Schatzker VI: transverse tibial metadiaphyseal fracture, along with any type of tibial plateau fracture (metaphyseal- diaphyseal discontinuity) ORTHO ANDALAS NOTES
AO / OTA CLASSIFICATION PROXIMAL TIBIA 41A Tibia, proximal end segment, extraarticular fracture 41B Tibia, proximal end segment, partial articular fracture 43C Tibia, proximal end segment, complete articular fracture ORTHO ANDALAS NOTES
42A Tibia, diaphyseal segment, simple fracture 42B Tibia, diaphyseal segment, wedge fracture 42C Tibia, diaphyseal segment, multifragmentary fracture AO / OTA CLASSIFICATION TIBIAL SHAFT ORTHO ANDALAS NOTES
43A Tibia, distal end segment, extraarticular fracture 43B Tibia, distal end segment, partial articular fracture 43C Tibia, distal end segment, complete articular fracture AO / OTA CLASSIFICATION DISTAL TIBIA ORTHO ANDALAS NOTES
PILON FRACTURE : RUEDI ALLGOWER BASED ON THE SEVERITY OF COMMINUTION AND THE DISPLACEMENT OF THE ARTICULAR SURFACE  Type I: Nondisplaced cleavage fracture of the ankle joint  Type II: Displaced fracture with minimal impaction or comminution  Type III: Displaced fracture with significant articular comminution and metaphyseal impaction ORTHO ANDALAS NOTES
44A Tibia/fibula, malleolar segment, infrasyndesmotic fibula injury 44B Tibia/fibula, malleolar segment, transsyndesmotic fibula fracture 44C Tibia/fibula, malleolar segment, suprasyndesmotic fibula fracture AO / OTA CLASSIFICATION ANKLE ORTHO ANDALAS NOTES
ROTATIONAL ANKLE FRACTURE : LAUGE HANSEN BASED ON “PURE” INJURY SEQUENCES, EACH SUBDIVIDED INTO STAGES OF INCREASING SEVERITY • This system is based on cadaveric studies. • Patterns may not always reflect clinical reality • The system takes into account (1) the position of the foot at the time of injury and (2) the direction • of the deforming force. ORTHO ANDALAS NOTES
ROTATIONAL ANKLE FRACTURE : LAUGE HANSEN 1. Supination–Adduction (SA)  This accounts for 10% to 20% of malleolar fractures.  This is the only type associated with medial displacement of the talus.  Stage I: Produces either a transverse avulsion-type fracture of the fibula distal to the level of the joint or a rupture of the lateral collateral ligaments  Stage II: Results in a vertical medial malleolus fracture ORTHO ANDALAS NOTES
ROTATIONAL ANKLE FRACTURE : LAUGE HANSEN 2. Supination–External Rotation (SER)  This accounts for 40% to 75% of malleolar fractures.  Stage I: Produces disruption of the anterior tibiofibular ligament with or without an associated avulsion fracture at its tibial or fibular attachment  Stage II: Results in the typical spiral fracture of the distal fibula, which runs from anteroinferior to posterosuperior  Stage III: Produces either a disruption of the posterior tibiofibular ligament or a fracture of the posterior malleolus  Stage IV: Produces either a transverse avulsion-type fracture of the medial malleolus or a rupture of the deltoid ligament ORTHO ANDALAS NOTES
ROTATIONAL ANKLE FRACTURE : LAUGE HANSEN 3. Pronation–Abduction (PA)  This accounts for 5% to 20% of malleolar fractures.  Stage I: Results in either a transverse fracture of the medial malleolus or a rupture of the deltoid ligament  Stage II: Produces either a rupture of the syndesmotic ligaments or an avulsion fracture at their insertion sites  Stage III: Produces a transverse or short oblique fracture of the distal fibula at or above the level of the syndesmosis; this results from a bending force that causes medial tension and lateral compression of the fibula, producing lateral comminution or a butterfly fragment ORTHO ANDALAS NOTES
ROTATIONAL ANKLE FRACTURE : LAUGE HANSEN 4. Pronation–External Rotation (PER)  This accounts for 5% to 20% of malleolus fractures.  Stage I: Produces either a transverse fracture of the medial malleolus or a rupture of the deltoid ligament  Stage II: Results in disruption of the anterior tibiofibular ligament with or without avulsion fracture at its insertion sites  Stage III: Results in a spiral fracture of the distal fibula at or above the level of the syndesmosis running from anterosuperior to posteroinferior  Stage IV: Produces either a rupture of the posterior tibiofibular ligament or an avulsion fracture of the posterolateral tibia ORTHO ANDALAS NOTES
ROTATIONAL ANKLE FRACTURE : LAUGE HANSEN 5. Danis–Weber  This is based on the level of the fibular fracture: the more proximal, the greater the risk of syndesmotic disruption and associated instability. Three types of fractures are described  Type A: This involves a fracture of the fibula below the level of the tibial plafond, an avulsion injury that results from supination of the foot and that may be associated with an oblique or vertical fracture of the medial malleolus. This is equivalent to the Lauge–Hansen supination–adduction injury.  Type B: This oblique or spiral fracture of the fibula is caused by external rotation occurring at or near the level of the syndesmosis; 50% have an associated disruption of the anterior syndesmotic ligament, whereas the posterior syndesmotic ligament remains intact and attached to the distal fibular fragment. There may be an associated injury to the medial structures or the posterior malleolus. This is equivalent to the Lauge–Hansen supination– external rotation injury.  Type C: This involves a fracture of the fibula above the level of the syndesmosis causing disruption of the syndesmosis almost always with associated medial injury. This category includes Maisonneuve-type injuries and corresponds to Lauge–Hansen pronation–external rotation or pronation–abduction stage III injuries. ORTHO ANDALAS NOTES
82A Foot, Calcaneus, extraarticular fracture 82B Foot, Calcaneus, Tongue-type fracture exiting into posterior facet 82C Foot, Calcaneus, complete articular joint depression fracture AO / OTA CLASSIFICATION CALCANEAL ORTHO ANDALAS NOTES
a Divergent (complete). b Medial divergent (incomplete). c Complete lateral divergent. LISFRANC FRACTURE-DISLOCATION CLASSIFICATION TARSOMETATARSAL ORTHO ANDALAS NOTES
AO-ICI CLASSIFICATION METATARSAL ORTHO ANDALAS NOTES
MIRELS CLASSIFICATION FOR PATHOLOGICAL FRACTURE RISK Classification 1 point • upper limb • involving <1/3 of bone diameter • blastic/sclerotic lesion • mild pain 2 points • lower limb • involving 1/3-2/3 of bone diameter • mixed sclerotic/lytic lesion • moderate pain 3 points • trochanteric region • involves >2/3 of bone diameter • lytic lesion • functional pain ORTHO ANDALAS NOTES
FRACTURE CLASSIFICATIONS THANKYOU

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FRACTURE CLAsfdfghdghgfhghSSIFICATIONS.pptx

  • 1.
    ORTHO ANDALAS NOTES @orthopaedi_unand ORTHOPAEDI &TRAUMATOLOGI FAKULTAS KEDOKTERAN UNAND
  • 2.
  • 3.
    FRACTURE CLASSIFICATIONS TABLE OF CONTENT: 1. UPPER LIMB 2. AXIAL 3. LOWER LIMB ORTHO ANDALAS NOTES
  • 4.
    UPPER LIMB FRACTURE CLASSIFICATION ORTHO ANDALASNOTES 1. Scapula 2. Acromial 3. Coracoid 4. Clavicle 5. Proximal humerus 6. Shaft humerus 7. Supracondylar humerus 8. Distal humerus 9. Radial head 10. Proximal ulnar 11. Radial shaft 12. Ulna shaft 13. Distal radius 14. Scaphoid 15. Metacarpal 16. Phalanges TABLE OF CONTENT
  • 5.
    FRACTURE OF SCAPULA:ZDARKOVIC AND DAMHOLT (BASED ON ANATOMICAL LOCATION)  AO/OTA Fracture and Dislocation Classification The scapula is numbered bone 14 : process (14A), body (14B), and glenoid fossa (14F).  Anatomic Classification (Zdravkovic and Damholt) (Fig. 13.1)  Type I: Scapula body  Type II: Apophyseal fractures, including the acromion and coracoid  Type III: Fractures of the superolateral angle, including the scapular neck and glenoid ORTHO ANDALAS NOTES
  • 6.
    IDEBERG CLASSIFICATION (BASED ONDISPLACEMENT OF THE ARTICULAR COMPONENT)  Ideberg Classification of Intra-Articular Glenoid Fractures  Type I: Avulsion fracture of the anterior margin  Type IIA: Transverse fracture through the glenoid fossa exiting inferiorly  Type IIB: Oblique fracture through the glenoid fossa exiting inferiorly  Type III: Oblique fracture through the glenoid exiting superiorly and often associated with an acromioclavicular joint injury  Type IV: Transverse fracture exiting through the medial border of the scapula  Type V: Combination of a type II and type IV pattern  Type VI: Comminuted glenoid fracture ORTHO ANDALAS NOTES
  • 7.
    CLASSIFICATION OF ACROMIALFRACTURES : KUHN ET AL (BASED ON DISPLACEMENT)  Type I: Minimally displaced  Type II: Displaced but does not reduce the subacromial space  Type III: Displaced with narrowing of the subacromial space ORTHO ANDALAS NOTES
  • 8.
    CLASSIFICATION OF CORACOIDFRACTURES: OGAWA (BASED ON LOCATION FROM CORACOCLAVICULAR LIGAMENT)  Type I: Proximal to the coracoclavicular ligament  Type II: Distal to the coracoclavicular ligament ORTHO ANDALAS NOTES
  • 9.
    CLAVICLE FRACTURE AO/OTA Fractureand Dislocation Classification  15.1 (proximal [medial]), 15.2 (diaphyseal), and 15.3 (distal [lateral]).  The proximal (medial) and distal (lateral) end segments are divided into types A (extraarticular), B (partial articular), and C (complete articular).  The diaphyseal seg-ment is divided into types A (simple), B (wedge), and C (multifragmentary) ORTHO ANDALAS NOTES
  • 10.
     Group I:fracture of the middle third (80%). This is the most common fracture in both children and adults; proximal and distal segments are secured by ligamentous and muscular attachments.  Group II: fracture of the distal third (15%)  Group III: fracture of the proximal third (5%). Minimal displacement results if the costoclavicular ligaments remain intact. It may represent epiphyseal injury in children and teenagers ALLMAN CLASSIFICATION (BASED ON ANATOMICAL LOCATION) ORTHO ANDALAS NOTES
  • 11.
    Type 1 isa fracture lateral to the coracoclavicular ligament, in which the conoid and trapezoid remain intact, with minimal displacement. Type 2A is a fracture medial to the coracoclavicular ligament, in which the conoid and trapezoid remain intact, with medial clavicle displacement. Type 2B is a fracture that occurs between or lateral to the coracoclavicular ligaments, in which the conoid is torn and the trapezoid may be intact, with medial clavicle displacement. Type 3 is an intra-articular fracture, in which the conoid and trapezoid remain intact, with minimal displacement. Type 4 is a physeal fracture in an immature skeleton, in which the conoid and trapezoid remain intact, with lateral clavicle displacement. Type 5 is a comminuted fracture, in which the conoid and trapezoid remain intact, with medial clavicle displacement. 1 AC, acromioclavicular. NEER CLASIFICATION (BASED ON THE RELATIONSHIP BETWEEN FRACTURES AND THE CORACOCLAVICULAR LIGAMENTS) ORTHO ANDALAS NOTES
  • 12.
  • 13.
  • 14.
    PROXIMAL HUMERUS FRACTURE AO/OTAFracture and Dislocation Classification ORTHO ANDALAS NOTES
  • 15.
    • One-part fractures:Nodisplaced fragments regardless of number of fracture lines • Two-part fractures (any of the following): • Anatomic neck • Surgical neck • Greater tuberosity • Lesser tuberosity • Three-part fractures: • Surgical neck with greater tuberosity • Surgical neck with lesser tuberosity • Four-part fractures • Fracture-dislocation • Articularsurfacefracture NEER CLASSIFICATION (BASED ON PART A FRAGMENT OF FRACTURE) ORTHO ANDALAS NOTES
  • 16.
    SHAFT HUMERUS FRACTURE (BASEDON PATTERN OF FRACTURE) AO/OTA Fracture and Dislocation Classification ORTHO ANDALAS NOTES
  • 17.
    SUPRACONDYLAR HUMERUS FRACTURE: GARTLAND (BASED ONTHE DEGREE OF DISPLACEMENT) 1. Extension Type  This represents 98% of supracondylar humerus fractures in children. This is based on the degree of displacement.  Type I: Nondisplaced  Type II: Displaced with intact posterior cortex; may be angulated or rotated  Type III: Complete displacement; posteromedial or posterolateral 2. Flexion Type  This comprises 2% of supracondylar humerus fractures in children.  Type I: Nondisplaced  Type II: Displaced with intact anterior cortex  Type III: Complete displacement; usually anterolateral ORTHO ANDALAS NOTES
  • 18.
    DISTAL HUMERUS FRACTURE (BASEDON ARTICULAR INVOLVEMENT) AO/OTA Fracture and Dislocation Classification ORTHO ANDALAS NOTES
  • 19.
    INTERCONDYLAR FRACTURE OFHUMERUS (BASED ONTHE DEGREE OF DISPLACEMENT)  Riseborough and Radin  Type I: Nondisplaced  Type II: Slight displacement with no rotation between the condylar fragments  Type III: Displacement with rotation  Type IV: Severe comminution of the articular surface ORTHO ANDALAS NOTES
  • 20.
    LATERAL AND MEDIALCONDYLE FRACTURE OF HUMERUS (BASED ON LOCATION OF THE COMMON FRACTURE LINES)  MILCH  Type I: Lateral trochlear ridge left intact  Type II: Lateral trochlear ridge part of the condylar fragment (medial or lateral) ORTHO ANDALAS NOTES
  • 21.
    RADIAL HEAD FRACTURE AO/OTAFracture and Dislocation Classification ORTHO ANDALAS NOTES
  • 22.
    MASON (BASED ON DEGREEOF DISPLACEMENT AND DISLOCATION)  Type I: Nondisplaced fractures  Type II: Marginal fractures with displacement (impaction, depression, angulation)  Type III: Comminuted fractures involving the entire head  Type IV: Associated with dislocation of the elbow (Johnston) ORTHO ANDALAS NOTES
  • 23.
    PROXIMAL ULNA FRACTURE AO/OTAFracture and Dislocation Classification ORTHO ANDALAS NOTES
  • 24.
    MAYO (BASED ON DISPLACEMENT,COMMINUTION,AND SUBLUXATION OR DISLOCATION) • Type I : fractures are nondisplaced or minimally displaced and are subclassified as either noncomminuted (type 1A) or comminuted (type 1B). • Type II : fractures have displacement of the proximal fragment without elbow instability • Type II A: fractures which are noncomminuted • TypeIIB : fractures are comminuted • Type III : fractures feature instability of the ulnohumeral joint and require surgical treatment. ORTHO ANDALAS NOTES
  • 25.
    SCHATZKER (BASED ON FRACTUREPATTERN) • Transverse: Occurs at the apex of the sigmoid notch and represents an avulsion fracture from a sudden, violent pull of both triceps and brachialis and uncommonly from direct trauma. • Transverse-impacted: A direct force leads to comminution and depression of the articular surface. • Oblique: Results from hyperextension injury; it begins at midpoint of the sigmoid notch and runs distally. • Comminuted fractures with associated injuries: Result from direct high energy trauma ; fractures of the coronoid process may lead to instability. • Oblique-distal : Fracture extends distal to the coronoid and compromises elbow stability. • Fracture-dislocation: Usually associated with severe trauma. ORTHO ANDALAS NOTES
  • 26.
    GALEAZZI FRACTURE ORRADIAL SHAFT FRACTURE (BASED ON FRACTURE PATTERN) • AO/OTA Fracture and Dislocation Classification ORTHO ANDALAS NOTES
  • 27.
    ULNA SHAFT FRACTUREAND MONTEGGIA FRACTURE  AO/OTA Fracture and Dislocation Classification ORTHO ANDALAS NOTES
  • 28.
     Type I:Anterior dislocation of the radial head with fracture of ulnar diaphysis at any level with anterior angulation  Type II: Posterior/posterolateral dislocation of the radial head with fracture of ulnar diaphysis with posterior angulation  Type III: Lateral/anterolateral dislocation of the radial head with fracture of ulnar metaphysis  Type IV: Anterior dislocation of the radial head with fractures of both radius and ulna within proximal third at the same level BADOO CLASSIFICATION OF MONTEGGIA (BASED ON DISLOCATION OF RADIAL HEAD) ORTHO ANDALAS NOTES
  • 29.
    DISTAL RADIUS FRACTURE (BASEDON FRACTURE PATTERN) AO/OTA Fracture and Dislocation Classification ORTHO ANDALAS NOTES
  • 30.
    FRYKMAN CLASSIFICATION (BASED ONTHE PATTERN OF INTRA-ARTICULAR INVOLVEMENT) ORTHO ANDALAS NOTES
  • 31.
    • Type I:Metaphyseal bending fracture with the inherent problems of loss of palmar tilt and radial shortening relative to the ulna (DRUJ injury) • Type II: Shearing fracture requiring reduction and often buttressing of the articular segment • Type III: Compression of the articular surface without the characteristic fragmentation; also the potential for significant interosseous ligament injury • Type IV: Avulsion fracture or radiocarpal fracture-dislocation • Type V: Combined injury with significant soft tissue involvement owing to high-energy injury FERNANDEZ CLASSIFICATION (BASED ON MECHANISM) ORTHO ANDALAS NOTES
  • 32.
  • 33.
    SCAPHOID FRACTURE (BASED ONLOCATION OF FRACTURE LINE) Mayo classification (based on location of fracture line)  Type I : Distal tubercle fracture  Type II : Distal articular surface fracture  Type III : Distal third fracture  Type IV : Middle third fracture  TypeV : Proximal third fracture ORTHO ANDALAS NOTES
  • 34.
  • 35.
  • 36.
  • 37.
  • 38.
    AXIAL FRACTURE CLASSIFICATION ORTHO ANDALASNOTES 1. Occipital condyle 2. Atlas 3. Odontoid process 4. Traumatic spondilolystesis 5. Compression 6. Distractive flexion 7. Compressive extension 8. Distractive extension 9. Lateral flexion 10. Clay’s Shoveler 11. Thoracolumbar 12. Burst fracture 13. Flexion-distraction injury TABLE OF CONTENT
  • 39.
    OCCIPITAL CONDYLE FRACTURES Type I: Impaction of condyle; usually stable  Type II: Shear injury associated with basilar or skull fractures; potentially unstable  Type III: Condylar avulsion; unstable ORTHO ANDALAS NOTES
  • 40.
    ATLAS FRACTURES :LEVINE 1. Isolated bony apophysis fracture 2. Isolated posterior arch fracture 3. Isolated anterior arch fracture 4. Comminuted lateral mass fracture 5. Burst fracture, also known as the Jefferson fracture ORTHO ANDALAS NOTES
  • 41.
    FRACTURES OF THEODONTOID PROCESS (DENS) : ANDERSON AND D’ALONZO  Type I: Oblique avulsion fracture of the apex (5%)  Type II: Fracture at the junction of the body and the neck; high nonunion rate, which can lead to myelopathy (60%)  Type III: Fracture extending into the cancellous body of C2 and possibly involving the lateral facets (30%) ORTHO ANDALAS NOTES
  • 42.
    TRAUMATIC SPONDYLOLISTHESIS OFC2 (HANGMAN’S FRACTURE): LEVINE AND EDWARDS  Type I: Nondisplaced, no angulation; translation <3 mm; C2–C3 disc intact (29%); relatively stable  Type IA: Atypical unstable lateral bending fractures that are obliquely displaced and usually involve only one pars interarticularis, extending anterior to the pars and into the body on the contralateral side  Type II: Significant angulation at C2–C3; translation >3 mm; most common injury pattern; unstable; C2–C3 disc disrupted (56%); subclassified into flexion, extension, and olisthetic types  Type IIA: Avulsion of entire C2–C3 intervertebral disc in flexion with injury to posterior longitudinal ligament, leaving the anterior longitudinal ligament intact; results in severe angulation; no translation; unstable; probably caused by flexion-distraction injury (6%); traction contraindicated  Type III: Rare; results from initial anterior facet dislocation of C2 on C3 followed by extension injury fracturing the neural arch; results in severe angulation and translation with unilateral or bilateral facet dislocation of C2–C3; unstable (9%); type III injuries most commonly associated with spinal cord injury; frank dislocation; extremely rare ORTHO ANDALAS NOTES
  • 43.
    INJURIES TO C3–C7 CLASSIFICATION(ALLEN-FERGUSON) COMPRESSIVE FLEXION (SHEAR MECHANISM RESULTING IN “TEARDROP” FRACTURES) ORTHO ANDALAS NOTES
  • 44.
  • 45.
  • 46.
  • 47.
  • 48.
  • 49.
  • 50.
    THORACOLUMBAR FRACTURE COMPRESSION FRACTURES (BASEDON END PLATE INVOLVEMENT ) ORTHO ANDALAS NOTES
  • 51.
    BURST FRACTURES (BASED ONEND PLATE INVOLVEMENT ) ORTHO ANDALAS NOTES
  • 52.
  • 53.
    FRACTURE DISLOCATIONS (BASED ON MECHANISMOF INJURY) ORTHO ANDALAS NOTES
  • 54.
  • 55.
  • 56.
    LOWER LIMB FRACTURE CLASSIFICATION ORTHO ANDALASNOTES 1. Pelvic 2. Acetabular 3. Femoral head 4. Femoral neck 5. Intertrochanteric 6. Subtrochanteric 7. Periprosthetic hip 8. Femoral shaft 9. Diaphyseal Femur 10. Distal femur 11. Patella 12. Floating knee 13. Tibial plateau 14. Proximal tibia 15. Tibial shaft 16. Distal tibia TABLE OF CONTENT 17. Pilon Fracture 18. Ankle 19. Calcaneal 20. Tarsometatarsal 21. Metatarsal
  • 57.
    PELVIC :YOUNG-BURGESS CLASSIFICATION (BASEDON INJURY MECHANISM) ORTHO ANDALAS NOTES
  • 58.
    PELVIC :YOUNG-BURGESS CLASSIFICATION BASEDON INJURY MECHANISM. ORTHO ANDALAS NOTES
  • 59.
    PELVIC :AO /OTA CLASSIFICATION. ORTHO ANDALAS NOTES
  • 60.
    ACETABULAR : LETOURNELCLASSIFICATION (BASED ON INVOLVEMENT OF ACETABULAR COLUMNS AND WALLS) The five elemental fracture types. a Posterior wall. b Posterior column. c Anterior wall. d Anterior column. E Transverse. ORTHO ANDALAS NOTES
  • 61.
    ACETABULAR : LETOURNELCLASSIFICATION BASED ON INVOLVEMENT OF ACETABULAR COLUMNS ANDWALLS The five associated fracture types. a Posterior column and wall. b Transverse and posterior wall. c T - t y p e . d Anterior column and posterior hemitransverse. e Both columns ORTHO ANDALAS NOTES
  • 62.
    ACETABULAR :AO /OTA CLASSIFICATION 62A Pelvis, acetabulum, partial articular, isolated column and/or wall fracture 62B Pelvis, acetabulum, partial articular, transverse type fracture 62C Pelvis, acetabulum, complete articular, associated both column fracture ORTHO ANDALAS NOTES
  • 63.
    FEMORAL HEAD: PIPKINCLASSIFICATION (BASED ON LOCATION OF FRACTURE RELATIVE TO FOVEA AND PRESENCE OR ABSENCE OF ASSOCIATED FRACTURES OF THE ACETABULUM OR FEMORAL NECK) ORTHO ANDALAS NOTES
  • 64.
    FEMORAL NECK: GARDENCLASSIFICATION BASED ON ORIENTATION OFTRABECULAR LINES AND DISPLACEMENT ORTHO ANDALAS NOTES
  • 65.
    FEMORAL NECK: PAUWELSCLASSIFICATION BASED ON ORIENTATION OF FRACTURE LINE ORTHO ANDALAS NOTES
  • 66.
    INTERTROCHANTERIC : BOYD& GRIFFIN CLASSIFICATION BASED ONTHE INVOLVEMENT OF SUBTROCHANTERIC REGION Type I : Stable Type II : Unstsble comminuted Type III : Unxtable reverse oblique Type IV : Intertrochanteric ORTHO ANDALAS NOTES
  • 67.
    SUBTROCHANTERIC : RUSSELL–TAYLOR CLASSIFICATION BASED ON INVOLVEMENT OF LESSERTROCHANTER AND PIRIFORMIS FOSSA ORTHO ANDALAS NOTES
  • 68.
    AO / OTACLASSIFICATION TROCHANTEERIC FEMUR 31A Femur, trochanteric fracture 31B Femur, neck fracture 31C Femur, head fracture ORTHO ANDALAS NOTES
  • 69.
    THEVANCOUVER CLASSIFICATION OFPERIPROSTHETIC HIP FRACTURES Vancouver classification (intraoperative) • considerations • location • pattern • stability of fracture • types • A - proximal metaphysis • B - diaphyseal • C - distal to stem tip (not amenable to insertion of longest revision stem) • subtypes • 1 - cortical perforation • 2 - nondisplaced crack • 3 - displaced unstable fracture pattern ORTHO ANDALAS NOTES
  • 70.
    FEMORAL SHAFT :BOYD & GRIFFIN CLASSIFICATION BASED ONTHE INVOLVEMENT OF SUBTROCHANTERIC REGION ORTHO ANDALAS NOTES
  • 71.
    AO / OTACLASSIFICATION DIAPHYSEAL FEMUR BASED ON FRACTURE PATTERN 32A Femur, diaphyseal segment, simple fracture 32B Femur, diaphyseal segment, wedge fracture 32C Femur, diaphyseal segment, multifragmentary fracture ORTHO ANDALAS NOTES
  • 72.
    AO / OTACLASSIFICATION DISTAL FEMUR BASED ON ARTICULAR INVOLVEMENT 33A Femur, distal end segment, extraarticular fracture 33B Femur, distal end segment, partial articular fracture 33C Femur, distal end segment, complete articular fracture ORTHO ANDALAS NOTES
  • 73.
    AO / OTACLASSIFICATION PATELLA BASED ON ARTICULAR INVOLVEMENT 34A Patella, extraarticular fracture 34B Patella, partial articular fracture 34C Patella, complete articular fracture, frontal/coronal plane ORTHO ANDALAS NOTES
  • 74.
    AO / OTACLASSIFICATION PATELLA • 34A1 Patella, extraarticular, avulsion fracture • 34B1 Patella, partial articular, sagittal, lateral fracture • 34B2 Patella, partial articular, sagittal, medial fracture • 34C1 Patella, complete articular, frontal/coronal, simple fracture • 34C2 Patella, complete articular, frontal/coronal, wedge fracture • 34C3 Patella, complete articular, frontal/coronal, multifragmentary fracture ORTHO ANDALAS NOTES
  • 75.
    FRASER CLASSIFICATION (FLOATINGKNEE) Fraser classification (floating knee) Type I: both fractures involve the shaft with articular involvement of the knee. Type II: articular involvement of the knee Type IIa: tibial plateau fractures Type IIb: intercondylar fractures (T orY fractures) of the inferior extremity of the femur Type IIc: both sites are articular ORTHO ANDALAS NOTES
  • 76.
    TIBIAL PLATEAU FRACTURE: SKATZKER CLASSIFICATION BASED ON LOCATION AND DEPRESS FRACTURE • Schatzker I: wedge-shaped pure cleavage fracture of the lateral tibial plateau, originally defined as having less than 4 mm of depression or displacement • Schatzker II: splitting and depression of the lateral tibial plateau; namely, type I fracture with a depressed component (generally considered commonest 5 ) • Schatzker III: pure depression of the lateral tibial plateau; divided into two subtypes • Schatzker IIIa: with lateral depression • Schatzker IIIb: with central depression • Schatzker IV: medial tibial plateau fracture with a split or depressed component • Schatzker V: wedge fracture of both lateral and medial tibial plateau • Schatzker VI: transverse tibial metadiaphyseal fracture, along with any type of tibial plateau fracture (metaphyseal- diaphyseal discontinuity) ORTHO ANDALAS NOTES
  • 77.
    AO / OTACLASSIFICATION PROXIMAL TIBIA 41A Tibia, proximal end segment, extraarticular fracture 41B Tibia, proximal end segment, partial articular fracture 43C Tibia, proximal end segment, complete articular fracture ORTHO ANDALAS NOTES
  • 78.
    42A Tibia, diaphysealsegment, simple fracture 42B Tibia, diaphyseal segment, wedge fracture 42C Tibia, diaphyseal segment, multifragmentary fracture AO / OTA CLASSIFICATION TIBIAL SHAFT ORTHO ANDALAS NOTES
  • 79.
    43A Tibia, distalend segment, extraarticular fracture 43B Tibia, distal end segment, partial articular fracture 43C Tibia, distal end segment, complete articular fracture AO / OTA CLASSIFICATION DISTAL TIBIA ORTHO ANDALAS NOTES
  • 80.
    PILON FRACTURE :RUEDI ALLGOWER BASED ON THE SEVERITY OF COMMINUTION AND THE DISPLACEMENT OF THE ARTICULAR SURFACE  Type I: Nondisplaced cleavage fracture of the ankle joint  Type II: Displaced fracture with minimal impaction or comminution  Type III: Displaced fracture with significant articular comminution and metaphyseal impaction ORTHO ANDALAS NOTES
  • 81.
    44A Tibia/fibula, malleolarsegment, infrasyndesmotic fibula injury 44B Tibia/fibula, malleolar segment, transsyndesmotic fibula fracture 44C Tibia/fibula, malleolar segment, suprasyndesmotic fibula fracture AO / OTA CLASSIFICATION ANKLE ORTHO ANDALAS NOTES
  • 82.
    ROTATIONAL ANKLE FRACTURE: LAUGE HANSEN BASED ON “PURE” INJURY SEQUENCES, EACH SUBDIVIDED INTO STAGES OF INCREASING SEVERITY • This system is based on cadaveric studies. • Patterns may not always reflect clinical reality • The system takes into account (1) the position of the foot at the time of injury and (2) the direction • of the deforming force. ORTHO ANDALAS NOTES
  • 83.
    ROTATIONAL ANKLE FRACTURE: LAUGE HANSEN 1. Supination–Adduction (SA)  This accounts for 10% to 20% of malleolar fractures.  This is the only type associated with medial displacement of the talus.  Stage I: Produces either a transverse avulsion-type fracture of the fibula distal to the level of the joint or a rupture of the lateral collateral ligaments  Stage II: Results in a vertical medial malleolus fracture ORTHO ANDALAS NOTES
  • 84.
    ROTATIONAL ANKLE FRACTURE: LAUGE HANSEN 2. Supination–External Rotation (SER)  This accounts for 40% to 75% of malleolar fractures.  Stage I: Produces disruption of the anterior tibiofibular ligament with or without an associated avulsion fracture at its tibial or fibular attachment  Stage II: Results in the typical spiral fracture of the distal fibula, which runs from anteroinferior to posterosuperior  Stage III: Produces either a disruption of the posterior tibiofibular ligament or a fracture of the posterior malleolus  Stage IV: Produces either a transverse avulsion-type fracture of the medial malleolus or a rupture of the deltoid ligament ORTHO ANDALAS NOTES
  • 85.
    ROTATIONAL ANKLE FRACTURE: LAUGE HANSEN 3. Pronation–Abduction (PA)  This accounts for 5% to 20% of malleolar fractures.  Stage I: Results in either a transverse fracture of the medial malleolus or a rupture of the deltoid ligament  Stage II: Produces either a rupture of the syndesmotic ligaments or an avulsion fracture at their insertion sites  Stage III: Produces a transverse or short oblique fracture of the distal fibula at or above the level of the syndesmosis; this results from a bending force that causes medial tension and lateral compression of the fibula, producing lateral comminution or a butterfly fragment ORTHO ANDALAS NOTES
  • 86.
    ROTATIONAL ANKLE FRACTURE: LAUGE HANSEN 4. Pronation–External Rotation (PER)  This accounts for 5% to 20% of malleolus fractures.  Stage I: Produces either a transverse fracture of the medial malleolus or a rupture of the deltoid ligament  Stage II: Results in disruption of the anterior tibiofibular ligament with or without avulsion fracture at its insertion sites  Stage III: Results in a spiral fracture of the distal fibula at or above the level of the syndesmosis running from anterosuperior to posteroinferior  Stage IV: Produces either a rupture of the posterior tibiofibular ligament or an avulsion fracture of the posterolateral tibia ORTHO ANDALAS NOTES
  • 87.
    ROTATIONAL ANKLE FRACTURE: LAUGE HANSEN 5. Danis–Weber  This is based on the level of the fibular fracture: the more proximal, the greater the risk of syndesmotic disruption and associated instability. Three types of fractures are described  Type A: This involves a fracture of the fibula below the level of the tibial plafond, an avulsion injury that results from supination of the foot and that may be associated with an oblique or vertical fracture of the medial malleolus. This is equivalent to the Lauge–Hansen supination–adduction injury.  Type B: This oblique or spiral fracture of the fibula is caused by external rotation occurring at or near the level of the syndesmosis; 50% have an associated disruption of the anterior syndesmotic ligament, whereas the posterior syndesmotic ligament remains intact and attached to the distal fibular fragment. There may be an associated injury to the medial structures or the posterior malleolus. This is equivalent to the Lauge–Hansen supination– external rotation injury.  Type C: This involves a fracture of the fibula above the level of the syndesmosis causing disruption of the syndesmosis almost always with associated medial injury. This category includes Maisonneuve-type injuries and corresponds to Lauge–Hansen pronation–external rotation or pronation–abduction stage III injuries. ORTHO ANDALAS NOTES
  • 88.
    82A Foot, Calcaneus,extraarticular fracture 82B Foot, Calcaneus, Tongue-type fracture exiting into posterior facet 82C Foot, Calcaneus, complete articular joint depression fracture AO / OTA CLASSIFICATION CALCANEAL ORTHO ANDALAS NOTES
  • 89.
    a Divergent (complete). bMedial divergent (incomplete). c Complete lateral divergent. LISFRANC FRACTURE-DISLOCATION CLASSIFICATION TARSOMETATARSAL ORTHO ANDALAS NOTES
  • 90.
  • 91.
    MIRELS CLASSIFICATION FORPATHOLOGICAL FRACTURE RISK Classification 1 point • upper limb • involving <1/3 of bone diameter • blastic/sclerotic lesion • mild pain 2 points • lower limb • involving 1/3-2/3 of bone diameter • mixed sclerotic/lytic lesion • moderate pain 3 points • trochanteric region • involves >2/3 of bone diameter • lytic lesion • functional pain ORTHO ANDALAS NOTES
  • 92.