Orthopaedic

1. Faculty of Clinical Sciences
Department of Orthopedics & Trauma Medicine
Physical Traumatology I
By
James K. Mwangi
Classification of
Fractures

2. Learning Objectives
Physical Traumatology; By the end of this unit;
Brief introduction
Define a fracture, dislocation & subluxation
Identify general causes, signs, & symptoms of fractures
Understand how fractures are identified
Explain the different fracture classifications
Understand the AO/OTA classification
Fracture Eponyms
Q & A
TAKE AWAY

3. Introduction
What is a bone?
A highly vascularized, living, constantly
changing mineralized connective tissue
It is innervated, contains vessels for
nutrition; bone cells to build up, maintain &
break down bone (important in fracture
healing).

4. Bone tissue
Bones can be classified based on anatomy & structure;
Anatomy
Long, short, flat, irregular bones, & sesamoid bones
Structure
Macroscopic
 Cortical bone
 Cancellous bone / spongy bone / trabecular bone
Microscopic
 Lamellar bone
 Woven bone

5. Bone tissue
Anatomic classification
Long bones
Short bones
Flat bones
Irregular bones
Sesamoid bones

6. Bone tissue
Macroscopic structure classification;
Cortical bone
80% of the skeleton
Characterized by slow turnover rate
Made-up of packed osteons / haversian systems
 Haversian canals
 Volkmann canals
Cancellous bone

7. Bone tissue
Macroscopic structure classification;
Cortical bone
Cancellous bone / spongy bone / trabecular bone
Higher turnover rate
30-90% of bone is porous & contains bone marrow

9. Bone tissue
Microscopic structure classification;
Woven bone
Immature or pathologic bone; collagen fiber in random orientation
More osteophytes
High turnover rate than lamellar
Weaker & more flexible than lamellar
Lamellar bone

10. Bone tissue
Microscopic structure classification;
Woven bone
Lamellar bone
Secondary bone formed from remodeling of woven bone
Well organized & stress oriented
Stronger & less flexible than woven bone
Slower turnover than woven bone

11. Bone tissue
Microscopic structure classification;
Woven bone
Lamellar bone
Secondary bone formed from remodeling of woven bone
Well organized & stress oriented
Stronger & less flexible than woven bone
Slower turnover than woven bone

12. Bone structure
Parts of a long bone;
Diaphysis
Epiphysis
Metaphysis
Articular cartilage
Periosteum & endosteum
(coverings)
Medullary cavity

13. Introduction
Definition
Fracture –
A complete or partial break in the continuity of a bone
Result of bone being loaded to failure

14. Introduction
Definition
Joint dislocation
Complete loss of congruity between the articular surfaces
Joint subluxation
Loss of congruity but the 2 surfaces are still in contact
Transient subluxation
During movement, a transient subluxation may cause sudden pain & the
sensation of something ‘slipping out’, but often reduces spontaneously

15. Introduction
Definition;
Fracture-dislocation
A complex injury comprising a fracture & a dislocation of the adjacent joint
Sprains
An incomplete tear of a ligament or tendon

16. Common Causes of #s

17. Causes
Common causes of fractures include;
Fall from a height
RTI
Direct injury
Repetitive force
Pathology

18. Signs & symptoms
What are some of the signs & symptoms
of a fracture?
Swelling / edema
Pain & tenderness
Numbness
Bleeding
Broken skin with bone protruding
Limitation to move a limb
Other S&S are complications related
Neuropathy, compartment syndrome, red cap
refill

19. Why classify fractures?
To guide the treatment
To estimate the prognosis
Anticipate & mitigate possible complications
For easier communication

20. Pathology of Fractures
Classification of fractures is based on;
Aetiology
Displacement
Relationship with external environment
Pattern
AO / OTA Classification
Based on eponyms

21. Pathology of Fractures
Classification of fractures is based on;
Aetiology
Traumatic fractures
Fragility fractures
Stress / fatigue fractures
Pathological fractures
Displacement
Relationship with external environment
Pattern

22. Pathology of Fractures
Classification of fractures is based on;
Aetiology
Traumatic fractures
 Direct force (direct injury)
 Indirect force (indirect injury)
Fragility fractures
Stress / fatigue fractures
Pathological fractures
Displacement
Relationship with external environment
Pattern

23. Pathology of Fractures
Classification of fractures is based on;
Aetiology
Traumatic fractures
Fragility fractures
 Fractures associated with bone weakness – Osteoporosis
Stress / fatigue fractures
Pathological fractures
Displacement
Relationship with external environment
Pattern

24. Pathology of Fractures
Classification of fractures is based on;
Aetiology
Traumatic fractures
Fragility fractures
Stress / fatigue fractures
 Normal bone – repetitive (heavy) loading, military personnel
 Common sites?
• Metatarsals, shaft of tibia, shaft of fibula, & NOF
Pathological fractures
Displacement
Relationship with external environment
Pattern

26. Pathology of Fractures
Classification of fractures is based on;
Aetiology
Traumatic fractures
Fragility fractures
Stress / fatigue fractures
Pathological fractures
 Occurs in bones weakened by a disease process – malignancy, Paget's disease,
osteogenesis imperfecta, O.M, bone cysts osteoporosis
 Following trivial force / trauma or spontaneously
Displacement
Relationship with external environment
Pattern

29. Pathology of Fractures
Classification of fractures is based on;
Aetiology
Displacement
Undisplaced fracture – frags in contact
Displaced fracture – frags not in contact
Relationship with external environment
Pattern

30. Pathology of Fractures
Classification of fractures is based on;
Aetiology
Displacement
Undisplaced fracture – frags in contact
Displaced fracture – frags not in contact
Factors responsible for displacement are?
 FRACTURING FORCE
 MUSCLE PULL ON FRACTURE FRAGMENTS
 GRAVITY
Relationship with external environment
Pattern

34. Pathology of Fractures
Classification of fractures is based on;
Aetiology
Displacement
How are fractures displaced?
Relationship with external environment
Pattern

35. Pathology of Fractures
Classification of fractures is based on;
Aetiology
Displacement
How are fractures displaced?
i. Translation (shift) – sideways, backward, forward
ii. Angulation (tilt) – angulated
iii. Rotation (twist)
iv. Length - shortening
Relationship with external environment
Pattern

48. Pathology of Fractures
Classification of fractures is based on;
Aetiology
Displacement
Relationship with external environment
Closed fractures –
 Overlying soft tissue cover is intact
Open fractures –
 Bone exposed.
 How does a fracture become open?
 How do we classify open fractures?
Pattern

50. Pathology of Fractures
Classification of fractures is based on;
Aetiology
Displacement
Relationship with external environment
Pattern – described by the # pattern, list the patterns?
Transverse #
Oblique #
Spiral #
Comminuted #
Segmental #
Compression / crush #
Greenstick #
Impacted #

54. AO / OTA Classification
What is OTA
Orthopaedic Trauma Association
What is AO
Association of Osteosynthesis
Reconstructive surgery aimed at stabilizing & joining the ends of a broken
bone after a fracture, an osteotomy (bone cutting procedure to realign &
reshape a bone or joint), or a non-union from a previous fracture

55. AO / OTA Classification
It aims at localizing the fracture
by describing
The bones & segments
Each bone & bone region is
numbered
1 – humerus
2 – radius & ulna
3 – femur
4 – tibia & fibula

56. AO / OTA Classification
Long bones are each divided into 3 segments;
1 – proximal
2 – shaft
3 – distal

57. AO / OTA Classification
After identifying the fractured bone and the location of
the fracture (bone & segment), next we identify the type
of fracture depending on the segment involved
Fracture type is defined as A, B, or C

58. AO / OTA Classification
Proximal segment 1 & Distal segment 3
Q. Is the fracture intra-articular or extra-articular?
A – extra-articular (doesn’t involve the joint surface)
B – partial articular (fracture involves one part of the articular surface)
C – complete articular (fracture has disrupted the joint surface)

61. AO / OTA Classification
Diaphyseal segment 2
Q. Is the fracture simple or multifragmentary?
A – Simple fracture (with a single circumferential fracture)
B – wedge (with one or more intermediate fragments)
C – Multifragmentary(multiple fragments, noncontact btwn P & D)

67. AO / OTA Classification
After identification of the bone, segment, and type of
fracture. We have groups & sub-groups for the fractures;
Ascending order of severity
According to the morphological complexity & difficulty in
treatment and prognosis
This is the fracture pattern
Either due to twisting (spiral) or bending forces

68. AO / OTA Classification
Group;
Spiral or twisting forces will produce a
Simple spiral (X2-A1), spiral wedge (X2-B1), or spiral fragmented complex
# (X2-C1)
Bending forces produce a
Simple oblique ((X2-A2), simple transverse (X2-A3), or Bending wedge (X2-
B2), fragmented wedge (X2-B3), complex # (X2-C3)
C2 fractures in the grouping is segmental by definition

70. AO / OTA Classification
AO summary
Which bone? H1, ru2, f3, tf4
Which segment? P1, s2, d3
Fracture type?
P & D – intra-articular, partial, complete articular = A, B, C
Shaft – simple, wedge, multifragmentary = A, B, C
Fracture group
Further defines the type

72. CLASSIFICATION
• Bone = 3
• Segment = 3
• Type = C
• Group = 3
• 33-c3

74. CLASSIFICATION
• Bone = 3
• Segment = 2
• Type = A
• Group = 3
• 32-A3

78. Pathology of Fractures
Fracture classification based on eponyms
These fractures are named after individuals who either discovered
or contributed significantly to the understanding of a specific type
of fracture
What are some of the fracture eponyms?

79. Pathology of Fractures
Fracture classification based on eponyms
What are some of the fracture eponyms?
Colles fracture
Smiths fracture
Galeazzi fracture
Monteggia fracture
Bennett's fracture
Rolando's fracture
Maisonneuve fracture
Segond's fracture
Chance fracture
Boxers fracture
Chauffer's fracture (Hutchinson's fracture)

80. Pathology of Fractures
Fracture classification based on eponyms
What are some of the fracture eponyms?
Colles fracture
 A fracture of the distal radius with dorsal (upward) displacement, often resulting
from a fall onto an outstretched hand. Named after Abraham Colles, who first
described the fracture in 1814.
Smiths fracture
 A distal radius fracture, but with volar (downward) displacement, often described
as the reverse of Colles' fracture. Named after Robert William Smith in 1847
Galeazzi fracture
 A fracture of the radius with associated dislocation of the distal radioulnar joint
(DRUJ). Named after Ricardo Galeazzi, who described it in 1934

81. Pathology of Fractures
Fracture classification based on eponyms
What are some of the fracture eponyms?
Monteggia fracture
 A fracture of the proximal third of the ulna with dislocation of the radial head.
Named after Giovanni Battista Monteggia in 1814
Bennetts fracture
 A fracture-dislocation of the base of the first metacarpal bone (thumb), involving
the carpometacarpal (CMC) joint. Named after Edward Hallaran Bennett, who
described it in 1882
Rolando's fracture
 A comminuted intra-articular fracture of the base of the first metacarpal
(thumb). It is often considered a more complex form of Bennett's fracture.
Named after Silvio Rolando.

82. Pathology of Fractures
Fracture classification based on eponyms
What are some of the fracture eponyms?
Potts fracture
 A fracture of the lower end of the fibula, often associated with damage to the
ligaments and dislocation of the ankle. Named after Percivall Pott, an English surgeon,
in the 18th century
Maisonneuve fracture
 A spiral fracture of the proximal third of the fibula associated with an ankle injury,
typically a disruption of the syndesmosis. Named after Jules Germain François
Maisonneuve, who described it in 1840.
Jones fracture
 A fracture at the base of the fifth metatarsal, typically caused by inversion of the
foot. Named after Sir Robert Jones, who reported it in 1902 after fracturing his own
foot.

83. Pathology of Fractures
Fracture classification based on eponyms
What are some of the fracture eponyms?
Segond's fracture
 A small avulsion fracture of the lateral aspect of the tibial plateau, often
associated with anterior cruciate ligament (ACL) injuries. Named after Paul
Segond's, who first described it in 1879
Holstein-Lewis fracture
 A fracture of the distal third of the humerus, often complicated by radial nerve
injury. Named after Arthur Holstein and George Lewis, who described the
fracture in 1963.

84. Pathology of Fractures
Fracture classification based on eponyms
What are some of the fracture eponyms?
Boxers fracture
 A fracture of the fifth metacarpal neck, often resulting from punching
something. Although not technically an eponym, it is colloquially referred to as
"Boxer's fracture" due to its association with fist fights.
Hutchinson's fracture (chauffeurs fracture)
 An intra-articular fracture of the radial styloid. Named after Jonathan
Hutchinson. It’s also called “Chauffeur’s fracture” because it commonly occurred
in early chauffeurs when hand-cranking a car engine.