CLASSIFICATION OF FRACTURES

ABH AY KU M AR G
8 TH TERM M BBS
RO LL N O . 01

M O D ERATO R : D r. M AN JU N ATH

FRACTURE CLASSIFICATION

Etiological

O n the basis of displacem ents

O n the basis of relationship w ith externalenvironm ent

O n the basis of PATTERN

Based on type of force causing fracture

Based on location

Fractures w ith eponym s

O n the basis of age

FR X /Fx/F x/#

ETIOLOGICAL CLASSIFICATION

Traum atic fracture (Fractures caused solely by

sudden injury)
D irect violence H eavy w t dropped on foot
Indirect violence transm itted along bone
eg. Clavicle # in fallon shoulder

Pathologicalfracture

Stress / Fatigue fracture

PATHOLOGICAL FRACTURE

Bone becom es w eak due to pathology so fracture

w ith trivialtraum a or spontaneous

W hen to suspect? M inor traum a

Problem w ith union? N on union

PATHOLOGICAL FRACTURES

PATHOLOGICAL FRACTURES

COMMON CAUSES AND SITES

M etastatic C a (lung, prostate, breast, thyroid,

kidney) Vertebralbodies (T/L), proxim alfem oral
shaft, proxim alhum erus

B on e cyst Radius

O steop orosis Vertebrae(T/L), neck/trochanter

of fem ur, low er end of radius

P ag ets d isease Shaft of tibia / fem ur

PATHOLOGICAL FRACTURES

PATHOLOGICAL FRACTURES

PATHOLOGICAL FRACTURES

PATHOLOGIC # AT DIFFERENT
AGES
AGE

C A U S ES

BIRTH O steog en esis im p erfecta

0 5 YR O steogenesis im perfecta
O steom yelitis
5 20 YR O steom yelitis
Sim ple bone cyst
Prim ary bone m alignancy
20 50 YR M alignancy
O steom alacia
G iant celltum or
Cystic lesions of bone
> 50 YR O steop orosis
M ultiple m yelom a
Secondaries in bone

FATIGUE FRACTURES

Athletes / m ilitary recruits

LL bones m etatarsals, tibia, fi

b ula, fem ur

N o single specifi
c causative injury

X ray changes appear after 2 4 w k

U sually no displacem ent of fragm ents

U sually hairline crack; transverse direction

A zone of callus surrounds # ; m ay be m istaken for

sarcom a

STRESS FRACTURES

STRESS FRACTURES

ON THE BASIS OF DISPLACEMENTS

U n d isp laced fractu re

D isp laced fractu re

pull/gravity

fracturing force/m uscle

- shift / angulation / rotation

ON THE BASIS OF
RELATIONSHIP WITH
EXTERNAL ENVIRONMENT

S im p le or C losed fractu re no com m unication

w ith externalenvt. O verlying skin/soft tissues
intact

C om p ou n d or op en fractu re skin or one of the

body cavities overlying the bone is broken.
C om m unicates w ith externalenvt. Exposed to
infection

CLOSED AND OPEN

FRACTURES

CLOSED AND OPEN

FRACTURES

OPEN FRACTURES

The presence of open w ound of skin in association w ith fracture

doesnt necessarily m ean the fracture is open

A direct com m unication m ust exist betw een the body surface
and the fractured bone ends

OPEN / COMPOUND
FRACTURES

1. Internalcom pounding Sharp fracture end

pierces skin from w ithin, resulting in an open
fracture

2. Externalcom pounding The object causing

fracture lacerates the skin and soft tissues over
bone, as it breaks it.

GUSTILO ANDERSON
CLASSIFICATION OF OPEN
FRACTURES
G U S TILO C LA SS IFIC ATIO N
I

Low energy, w ound < 1 cm , internalcom pounding

II

W ound > 1 cm , < 10 cm w ith m oderate tissue dam age and

m inim aldevitalised soft tissue
H igh energy w ound > 1 cm w ith extensive tissue dam age /
> 10 cm even w ith soft tissue coverage

III

IIIa

Adequate soft tissue cover

IIIb

Inadequate soft tissue cover

IIIc

Associated w ith arterial(vascular) injury

Ramon
Gustilo

GUSTILO ANDERSON
CLASSIFICATION

PROGNOSIS

G ustilo grade I: infection rate 0% ;

am putation rate 0-2%

G ustilo grade II: infection rate 0% ;

am putation rate 2-7%

G ustilo grade IIIA:

infection rate 7% ;
am putation rate 2.5%

G ustilo grade IIIB:

infection rate 10-50% ;
am putation rate 5.6%

G ustilo grade IIIC :

infection rate 25-50% ;
am putation rate 25%

GUSTILO-ANDERSON
CLASSIFICATION
DISADVANTAGES
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ON THE BASIS OF PATTERN

Transverse fracture (< 30 deg)

O blique fracture (> 30 deg)

Spiralfracture

C om m inuted fracture

Segm entalfracture

C om pression fracture

G reenstick fracture
M ultifragm entary # - W edge and
com plex

PATTERNS OF FRACTURE

???

LIN EA R FR A C TU R E

???

S P IR A L FR A C TU R E

TORUS / BUCKLE FRACTURE

L. torus sw elling/protruberance

C hildren

Incom plete #

Fallon O S hand

H ealfast

C om pression #

TRANSVERSE vs OBLIQUE #

IMPACTED / COMPACTED
FRACTURE

Bone fragm ents

driven into each
other

H olstein-Lew is fracture - N erve

HAIRLINE FRACTURE

= capillary fracture

BASED ON TYPE OF FORCE

CAUSING FRACTURE

Tw isting Spiral#

C om pression Short oblique #

Bending - # w ith butterfl

y segm ent

Tension Breaks bone transversely / avulsion

BASED ON LOCATION

Proxim althird

M iddle third

D istalthird
OR

Epiphyseal

M etaphyseal

D iaphyseal

(AN ATO M ICAL

CLASSIFICATIO N )

CLASSIFICATION BASED ON
AGE

Pediatric

Adult

G eriatric

(Causes diff
er, pathology diff
ers, treatm ent diff
ers)

RADIOLOGICAL
CLASSIFICATION

Intra-articular

Extra-articular fracture

Partially articular fracture

DEPENDING ON NUMBER OF
FRAGMENTS

O ne part fracture

Tw o part fracture

Three part fracture

Four part fracture

BASED ON COMPLICATIONS

U ncom plicated fracture

C om plicated fracture
Intra-articular fracture
Epiphysealfracture
N erve injury
Arterialinjury,etc.

Bones are like seeds in the soilof soft tissue

COMPLETE AND INCOMPLETE

FRACTURES

C O M P LETE
Transverse
O blique
Spiral
Im pacted
Com m inuted

IN C O M P LETE
G reenstick fracture
Com pression fracture

TYPICAL AND ATYPICAL

FRACTURES

TYPIC AL

ATYPIC AL
Com pression
Pathological
G reenstick
Torus

MULLERS ALPHANUMERIC
CLASSIFICATION

First digit specifi

es bone

A letter specifi
es the type of fracture

Tw o further num bers specify detailed m orphology

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MULLERS CLASSIFICATION

FRACTURES WITH EPONYMS

M onteggia fracture dislocation

G aleazzifracture dislocation

N ight stick fracture

C olles fracture

Contd..

FRACTURES WITH EPONYMS

Sm ith fracture

Barton fracture

C haff
eur fracture

Bennett fracture

Contd..

FRACTURES WITH EPONYMS

Boxers fracture

W hiplash injury

Bum per fracture

Potts fracture

Contd..

FRACTURES WITH EPONYMS

C ottons fracture

M assonaise fracture

Pilon fracture

Aviator fracture

Contd..

FRACTURES WITH EPONYMS

C hopart fracture dislocation

Jones fracture

Rolando fracture

Jeff
erson fracture

Contd..

FRACTURES WITH EPONYMS

C lay Shoveller fracture

C hance fracture

M arch fracture

Burst fracture

Contd..

FRACTURES WITH EPONYMS

H angm an fracture

D ashboard fracture

Straddle fracture

M algaigne fracture

M allet fi
n ger

OTA CLASSIFICATION

Bone

Location

Type (A/B/C-Sim ple/W edge/C om plex)

G roup (G eom etry)

Subgroup (O ther features)

DEPENDING ON SITES
INVOLVED

Single site fracture

M ultiple site fracture

Polytraum a

CLASSIFICATION OF REGIONAL
FRACTURES

N eer classifi
cation:H um erus

D en is classifi
cation:Spine

S ein sh eim er's C lassifi

cation:Fem ur

Frykm an classifi
cation: Radius and ulna

Letou rn el an d Ju d et Classifi
cation:Acetabular
fractures

ACKNOWLEDGEMENTS

D ean and D irector, BM C RI

D ept of O rthopedics, BM CRI

D r. M anjunath sir, Prof & H ead, D ept of

O rthopedics, B & LC H

D r. Vanam alisir

Allof u

REFERENCES

EssentialO rthopedics, JM aheshw ari, 3 rd Ed, M ehta

Publishers

Textbook of O rthopedics, John Ebnezar, 3 rd Ed

Apleys textbook of O rthopedics

PH RAKKC H U RR

THANQ