This document discusses fracture classification systems. It begins by defining a fracture and explaining why fractures are classified. Some common classification bases are described, including etiology, environment, morphology, site, and displacement. Specific classification systems are then outlined, such as the ICRC system for war wounds, AO system, Gustilo-Anderson for open fractures, and others for pediatric, pelvic, acetabular, femoral neck, tibial plateau, ankle, and spinal fractures. The conclusion emphasizes how classification helps standardize communication, guide treatment, and predict outcomes.

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: