This document discusses different types and classifications of fractures. It begins by describing the key components of anatomic fracture description: type, comminution, location, and displacement. It then defines and provides examples of different fracture types, levels of comminution, anatomical locations, and degrees of displacement. The document also discusses several common fracture classification systems including AO classification and Salter-Harris classification of pediatric fractures. It concludes by defining types of fractures such as oblique, comminuted, spiral, compound, and greenstick fractures.

1. Fracture Description &
Classification
By Daaneyal J. Dilawar

2. Anatomic description of fractures
 Type
 Comminution
 Location
 Displacement

3. Anatomic description - Type
 Type is the overall
fracture pattern
 Examples are:
– Simple
– Spiral
– segmental

4. Anatomic description -
Communition
 Comminution is the measure of the
number of pieces of broken bone that
there are.
 Examples are: non-comminuted or
mildly comminuted or severely
comminuted

5. Anatomic description - Location
 Location is the anatomic location of the
fracture usually described by giving the
bone involved and location on the bone
 Examples are: distal radial shaft,
proximal 1/3 humeral shaft, intra-
articular distal tibial

6. Anatomic description -
Displacement
 Displacement is the amount the pieces
of a fracture have moved from their
normal location
 Can be displaced or non-displaced
 Subdivided into 3 sub-categories:
translation, angulation, and shortening

7. Displacement - Translation
 Translation is
sideways motion of
the fracture - usually
described as a
percentage of
movement when
compared to the
diameter of the
bone.

8. Displacement - Angulation
 Angulation is the
amount of bend at a
fracture described in
degrees.
Described with
respect to the apex
of the angle or with
respect to direction
of distal fragment.

9. Displacement - Shortening
 Shortening is the
amount a fracture is
collapsed expressed
in centimeters.
Sometimes called
bayonette
apposition.

10. Anatomic description?

11. Anatomic description
 Simple, transverse,
non-communited
midshaft radial and
ulnar fracture with
30 degrees apex
radial angulation.

12. Anatomic description??

13. Anatomic description
 Simple, transverse,
non-communited
distal radial and
ulnar fracture with
100% radial
translation, 45
degrees apex ulnar
angulation and 2 cm
of shortening.

14. Why classify fractures?
 Classification or description of fractures
is only used when the classification or
description is useful in providing
treatment or outcomes

15. Types of classifications
 Anatomic description
 AO classification
 Salter-Harris classification
 Gustillo open fracture classification
 Fracture specific classifications

16. AO Classification

17. AO Classification
 1st
number = long bone
 2nd
number = bone segment
 Letter = fracture type (A,B,C)
 Then 3rd
& 4th
numbers classify fracture group
& subgroup

18. Salter-Harris Classification
 Only used for pediatric fractures that
involve the growth plate (physis)
 Five types (I-V)

19. Salter-Harris type I fracture
 Type I fracture is
when there is a
fracture across the
physis with no
metaphysial or
epiphysial injury

20. Salter-Harris type II fracture
 Type II fracture is
when there is a
fracture across the
physis which
extends into the
metaphysis

21. Salter-Harris type III fracture
 Type III fracture is
when there is a
fracture across the
physis which
extends into the
epiphysis

22. Salter-Harris type IV fracture
 Type IV fracture is
when there is a
fracture through
metaphysis, physis,
and epiphysis

23. Salter-Harris type V fracture
 Type V fracture is
when there is a
crush injury to the
physis

24. Gustillo classification
 The Gustillo classification is used to
classify open fracture - ones in which
the skin has been disrupted
 Three grades that try to quantify the
amount of soft tissue damage
associated with the fracture

25. Open fractures - grade 1
 wound less than 1 cm w/ minimal soft
tissue injury
 wound bed is clean
 bone injury is simple w/ minimal
comminution
 w/ IM nailing, average time to union is
21-28 weeks

26. Open fractures - grade 2
 wound is greater than 1 cm w/
moderate soft tissue injury
 wound bed is moderately contaminated
 fracture contains moderate
comminution
 w/ IM nailing, average time to union is
26-28 weeks

27. Open fractures - grade 3A
 wound greater than 10 cm w/ crushed
tissue and contamination
 soft tissue coverage of bone is usually
possible
 w/ IM nailing, average time to union is
30-35 weeks

28. Open fractures - grade 3B
 wound greater than 10 cm w/ crushed
tissue and contamination
 soft tissue is inadequate and requires
regional or free flap
 w/ IM nailing, average time to union is
30-35 weeks

29. Open fractures - grade 3C
 is fracture in which there is a major
vascular injury requiring repair for limb
salvage
 fractures can be classified using the
MESS
 in some cases it will be necessary to
consider BKA following tibial fracture

30. Types Of Fractures
 Oblique: Break Occurs Diagonally Across the Bone
 Comminuted: Bone Is Broken, Splintered or Crushed
Into a Number of Pieces
 Spiral: The Break Travels Around the Bone.
 Compound: The Bone Sticks Through the Skin.

31. Types Of Fractures
 Greenstick
– Bone Cracks One Side Only
– Not All the Way Through
– Usually Only Seen in Children Due to Softness of Their Bones
 Transverse: Complete Fracture in Which the Break Is
Straight Across the Bone
 Simple Or Closed
– Partial Break on Bone
– No Open Skin Wound

32. Compound Fracture
 Also Called an Open Fracture
 Occurs When There is a Break in the Skin Around a Broken Bone.
 To Be Classified as Compound Fracture,
– Outside Air (and Dirt and Bacteria) Must Be Able to Get to the
Fracture Site Without a Barrier of Skin or Soft-Tissue.
– Therefore, Bone Does Not Need to be Through the Skin in Order
for the Injury to be Called a Compound Fracture.

33. The Fuss About Compound
Fractures
 Injuries Are Open to the Outside World
– There Is a Very Significant Risk of Developing an
Infection Around the Fracture.
– If Infection Develops, There Can Be Problems with
Healing Process
 Therefore, Compound Fractures Are
Generally Treated with Surgery to Clean the
Site of Injury and Stabilize the Fracture.

34. Compound Fracture X-Ray

35. Spiral Fracture
 Also Called Torsion
Fracture
 Break Spirals Around the
Bone
 Common In a Twisting
Injury
 Can Only Be Caused If a
Limb (Arm or Leg) Is
Twisted in Such a Way
That Causes the Bone to
Break.

36. Spiral Fracture
 Caused by Certain
Types of Accidents
– Especially in Sports,
Especially Skiing
 Abuse
– Arm or Leg is Twisted
by the Abuser

37. Causes Of Spiral Fracture
 In Skiing - skiers lock their feet into the skis in sturdy ski
boots, if a ski breaks or the skier loses control and the
ski rotates, the leg may be violently twisted in one
direction, creating a textbook spiral fracture.
 Spiral Fracture has become famous as a warning sign
of abuse, especially in children, because the twisting
motion necessary could be caused by something such
as a parent or guardian grabbing and twisting the arm
or leg of a child. When doctors see spiral fractures in
children, it may set off warning bells.

38. Sprial Fracture X-Ray

39. Greenstick Fractures
 Commonly Seen in
Children
– Bones Are softer and More
Flexible Than Those of an
Adult, So They're More
Likely to Bend Than Break
Completely
– Flexibility Can Result in a
Greenstick Fracture.
– Bone Cracks but doesn't
Break All the Way Through
- Like When One Tries to
Break a Green Stick of
Wood

40. Greenstick Fractures
 May Occur When a Child Falls While Playing or
Participating in Sports.
 Arm Bones Are the Most Likely to be Harmed
Because of the Instinct to Throw out the Arms
to Catch Fall.
 Can Be Difficult to Diagnose, Because It May
Not Cause All the Classic Signs and Symptoms
of a Broken Bone

41. Greenstick Fracture X-Ray

42. Thank You!