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OPEN FRACTURES – GUSTILLO AND ANDERSON Type I – Wound <1cm long, little ST damage, no sign of crush, simple/transverse/oblique fx w/ little comminution Type II – Wound >1cm long, minor ST damage, slight/moderate crush injury, moderate comminution Type III – Extensive ST injury, high degree of comminution
IIIa – ST coverage of bone is adequate, trauma high-energy IIIb – extensive ST damage requiring free-flap for coverage, assoc w/ periosteal stripping and ST contamination IIIc – any open fx w/ arterial injury requiring immediate repair
Type IV – Intraarticular comminuted fx Type V – (peds) Extraarticular fx through epiphysis Type I Type II Type III Type IV Type V TORG CLASSIFICATION Type I – Acute Jones fx Type II – Delayed-union Jones or diaphyseal stress fx Type III – Non-union Jones or diaphyseal stress fx CHAPMAN CLASSIFICATION Type Ia – Non-displaced Jones fx Type Ib – Displaced or comminuted Jones fx Type II – Delayed or non-union Jones fx Type IIIa – Non-articular styloid process fx Type IIIb – Articular styloid process fx NAVICULAR FRACTURES – WATSON/JONES CLASSIFICATION Type I – Avulsion fx off tuberosity by PT tendon Type II – Dorsal lip fx, may resemble os supranaviculare Type IIIa – Transverse fx, non-displaced Type IIIb – Transverse fx, displaced Type IV – Stress fx LISFRANC’S FRACTURES – HARDCASTLE CLASSIFICATION Type A – either homolateral (metatarsals displaced laterally) or homomedial (metatarsals displaced medially.) Type B – Partial incongruity; not all metatarsals are displaced in the same direction. Type C – Divergent; 1st metatarsal is medially dislocated, 2-5 are either partially or completely laterally dislocated.
CLOSED FRACTURES – ROCKWOOD AND GREEN Type I – Direct Trauma; closed fx by a direct blow
A – Tapping Fx; low velocity blow, little comminution and little ST damage B – Crush Fx; high velocity blow, extensive ST injury & comminution
Type II – Indirect Trauma; closed fx from force acting distant to the fx site
A – Traction Fx; transverse avulsion fx at site of tendon or ligament B – Angulation Fx; transverse fx caused by bending of long bone C – Spiral Fx; oblique fx 45° from axis of long bone, by rotational force D – Compression Fx; impaction of shaft into soft cancellous bone E – Angulation and Axial Compression Fx; transverse fx w/ butterfly fragment F – Angulation and Rotation Fx; causes oblique fx lines
FRACTURE STABILITY – CHARNLEY Most Stable – transverse fx Potentially Stable – short obliqe fx, <45° from transverse Least Stable – long oblique, >45°, comminuted fxs NON-UNIONS – WEBER & CECH Hypertrophic Type (vascular, reactive) 1. Elephant’s foot 2. Horse’s hoof 3. Oligotrophic Atrophic Type (avascular, non-reactive) 1. Torsion wedge 2. Comminuted 3. Defect 4. Atrophic 1 MPJ DISLOCATIONS – JAHSS CLASSIFICATION Type I – Hallux/sesamoid dislocation, no disruption of sesamoid apparatus, irreducible to closed reduction. Type IIa – closed reducible, disrupted intersesamoidal ligament Type IIb – closed reducible, transverse fx of sesamoids Type IIc – open reduction, both IIa and IIb.
5 METATARSAL BASE FRACTURES – STEWART CLASSIFICATION
Type I – “Jones Fracture,” transverse fx of diaphyseal / metaphyseal junction. Healing potential is poor. Type II – Intraarticular avulsion fx Type III – Extraarticular avulsion fx
View w/ axial calcaneal. vertical/horizontal body fx. Isherwood View: Lateral oblique axial to visualize posterior facet. Type Vb – intraarticular fx of the calcaneo-cuboid joint. edema about heel. may appear similar to os calcaneum secundum. View w/ lateral foot. beak/medial avulsion fx. Normal = 25 -40 degrees.” meaning a lift-off of the posterior Type IVa&b – same as type III. Type IIb – avulsion fx of the tendo Achilles. but comminuted. pain w/ compression/palpation. fx lowers or reduces this angle Critial Angle of Gissane: Measure of calcaneal strut that supports the lateral talar process. Type IIIa – simple fx. ESSEX-LOPRESTI CLASSIFICATION Type Ia – tuberosity fx. axial calcaneal. Occurs as a bifurcate ligament avulsion. medial oblique axial to visualize middle articular facet. lat oblique isherwood. Normal = 130 degrees. lateral foot. Occurs secondary to a fall. and lateral oblique to visualize anterior process. secondary to adduction and plantarflexion. QUENU & KUSS CLASSIFICATION Type A – Homolateral/partial incongruity of Lisfranc’s joint Type B – Isolateral/partial incongruity or Lisfranc’s joint Type C – Divergent fx. Type IIa – “beak fracture. fx blisters on skin. View w/ lateral foot radiograph. ROWE CLASSIFICATION Type Ia – plantar calcaneal tuberosity fx. Type Va – intraarticular STJ fx w/ comminution and depression of the articular segment. same as a IIa but with complete dislocation. pain w/ STJ motion.) View w/ axial calcaneal. plantar medial&lateral ecchymosis (mondur’s sign) Bohler’s Angle: Measures sagittal plane relationship of talus and calcaneus – compare to contralateral side. intraarticular fx will decrease Broden View: Lateral oblique projection to visualize the posterior facet and a medial oblique to view the sinus tarsi. Type Ib – shearing fx of the sustentaculum tali. landing on both heels w/ the feet inverted or everted.superior surface of the calcaneus. secondary to inverted landing of heel. Type IIIb – same as IIIa. Type Ic – anterior process fx. oblique through calcaneal body not involving the STJ. but w/ STJ involvement. dislocation of Lisfranc’s joint CALCANEAL FRACTURES Signs & Symptoms: Acute pain. (Rowe types I and II) . some cortex still intact. View w/ lateral. secondary to eversion force (medial tuberosity) or inversion (lateral tuberosity. Occurs when heel strikes ground w/ knee extended and foot dorsiflexed.
secondary fx line exits posteriorly through calcaneus. and BC) – three part fx w/ central depressed segment. For Rowe class IV and V (intraarticular – 75% chance) then a coronal CT scan is indicated. Anterior STJ fragment 3. articular HANNOVER CLASSIFICATION CT evaluation of fragmentation – 5 general fragments 1. B. DEGAN CLASSIFICATION Type I – Non-displaced fx of anterior process Type II – Displaced fx of anterior process. Type II (A. 7-15% chance of AVN Type II – STJ subluxation. and C) – two part fx of posterior facet. secondary fx line exits dorsally through calcaneus and a fragment dislocates. and C) – nondisplaced articular fx. extra-articular Type III – Displaced fx of anterior process.) Type I (A. Sustentaculum 2. Tuberosity 5. Stage II – partially detached osteochondral fragment. -The current standard for calcaneal classification is the Rowe system. 100% chance of AVN Hawkin’s Sign – subchondral lucency of the body of the talus following fx. Type IIc – comminuted STJ fx. in crater. Type IV – comminuted fx of posterior facet. Type III (AB. Stage III – completely detached fragment. 85% chance of AVN Type IV – STJ/ankle/TNJ dislocation. Anterior process TALAR NECK FRACTURES – HAWKIN’S CLASSIFICATION These fxs are usually seen in MVAs or short-height falls Type I – minimal displacement. AC. B. STJ 4. appears 6-8 weeks post fx. and the Sanders system is typically used to classify. 35-50% chance of AVN Type III – ankle dislocation. Type IIb – displaced STJ fx. . WATSON-JONES CLASSIFICATION Not involving the STJ Type A – vertical fracture of tuberosity Type B – horizontal fracture of tuberosity Type C – fracture of sustentaculum tali Type D – fracture of the anterior process Involving the STJ Type A – undisplaced fracture through body Type B – displaced fracture through body Type C – fracture w/ comminution and displacement of STJ SANDER’S CLASSIFICATION (Note: This classification system requires the fracture to be visualized w/ coronal CT scan. = revascularization TALAR DOME LESIONS – BERNDT-HARDY CLASSIFICATION Stage I – small area of compression in subchondral bone.Type Ib – calcaneo-cuboid joint involvement Type IIa – undisplaced STJ fx.
Lateral Lesions: (DIAL. 44% ) Thin. easily displaced. cup shaped. Medial Lesions: (PIMP. wafer shaped. Thurston Holland Sign – triangle shaped metaphyseal fx. stable Stage D – Flap present or bone exposed. compacted germinal cells of physis die and cause premature closure. + Thurston Holland sign. out of crater. non-displaced fragment. plantarflexion inversion = medial posterior lesion. intact. Type II – fx line extends through physis and exits metaphysis. Type III – fx line extends through physis and exits epiphysis (intraarticular).displaced FRACTURES OF THE LATERAL PROCESS OF THE TALUS . unstable Stage E – Loose. and metaphysis.non-displaced sagittal fx Group III – Posterior Tubercle Fracture – Shepherd’s Fx Group IV – Lateral Process Fracture (Fjeldborg) Group V – Crush injury – highly comminuted BOYD & KNIGHT CLASSIFICATION Type I – Coronal or sagittal shear fracture Ia – Non-displaced Ib – fx w/ displacement at ankle joint Type I – shearing force. Shearing or avulsion force. Poor prognosis. requires ORIF Type 1a – non-displaced Type 1b – displacement of trochlear surface Type 1c – displacement of trochlear surface w/ STJ dislocation Type 1d – total dislocation of talar body Type 2a – displaced horizontal fx Type 2b – non-displaced horizontal fx Type 3a – displaced sagittal fx Type 3b . Type V – compression fx. Type IV – intraarticular fx through epiphysis.SNEPPEN Group I – Talar Dome Fracture/OCD (use Berndt-Hardy) Group IIa – Shear Fracture – 50% AVN. growth lines Type IX (Ogden) – degloving loss of periosteum on diaphysis POLAND CLASSIFICATION Types I to III – same as salter-harris I to III Type IV – fx through entire physis w/ epiphyseal fx as well PETERSON CLASSIFICATION Type I – Transverse fx of metaphysis w/ longitudinal compression of physis . Type VI (Rang) . less likely to displace. Due to shearing force. Poor prognosis. stable Stage B – Rough surface. Ic – fx w/ ankle & STJ displacement Id – fx w/ total displacement Type II – Horizontal shear fracture IIa – Non-displaced IIb . Type VII (Ogden) – epiphyseal fx not affecting physis Type VIII (Ogden) – partial fx of metaphysis. stable Stage C – Fibrillation/fissuing.contusion of perichondral ring of physis. MRI STAGING OF TALAR DOME FRACTURES Stage I – injury to articular cartilage only Stage II – cartilage injury w/ underlying fracture IIa – w/ bone edema IIb – w/o bone edema Stage III – detached (rim signal) but not displaced fragment Stage IV – displaced fragment Stage V – subchondral cyst ARTHROSCOPIC STAGING OF TALAR DOME FRACTURES Stage A – Smooth. acts like type V if a bony bridge develops – prognosis good. Prognosis is poor. separation of epiphysis from metaphysis w/o fx. 56%) Deep.FJELDBORG Type I – Incomplete fx (no ORIF necessary) Type II – Fx w/ displacement (ORIF) Type III – Fracture w/ STJ dislocation (ORIF) HAWKIN’S CLASSIFICATION Type I – Simple fx from AJ articulation to STJ Type II – Comminuted fx involving calcaneal & fibular articulations Type III – Chip fx of anterior/inferior portion of lat process SHEPHERD’S FRACTURES – DOBAS & WATSON Stage I – Normal lateral tubercle. intact but soft. seen at birth and in young children.Stage IV – complete fx. no clinical significance Stage II – Enlarged lateral tubercle Stage III – Non-fused os trigonum Stage IV – Synchondratic union of os trigonum to talus EPIPHYSEAL FRACTURES – SALTER-HARRIS CLASSIFICATION DIAL a PIMP denotes the location of talar dome lesions – dorsiflexion internal rotation = anterior lateral lesion. unstable Stage F – Displaced fragment FRACTURES OF THE TALAR BODY . physis.
Maisonneuve Fracture – proximal fibular fx (near head) as a result of torsional stress (PER). as in lawnmower injury or farm equipment WEBER CLASSIFICATION Type A – Extra-articular A1 – Separation of physis A2 – Fragmentation of epi/metaphysis Type B – Intra-articular B1 – w/in physis. the second word denotes the position of Supination-External Rotation Pronation-External Rotation Pronation-Dorsiflexion CHRONIC TIBIOFIBULAR DIASTASIS – EDWARDS & DELEE . EPONYMOUS ANKLE FRACTURES Pott’s/Dupuytren’s Fracture – bimalleolar fx Cotton’s Fracture – trimalleolar fx. Bosworth Fracture – mid-fibular fx w/ ankle dislocation Tillaux-Chaput Fracture – avulsion fx of anterior inferior lateral tibia Wagstaffe Fracture – avulsion fx of ant inferior medial tibia Volkmann Fracture – posterior tibial fracture MEDIAL MALLEOLAR FRACTURE – MULLER CLASSIFCATION Supination – Adduction Pronation-Abduction Type A – Avulsion of tip of medial malleolus Type B – Avulsion at the level of the ankle joint Type C – Oblique fx Type D – Vertical orientation LATERAL MALLEOLAR FRACTURE – DANIS-WEBER CLASSIFICATION Type A – Fracture below the level of the tibial plafond Type B – Fracture at the level of the tibial plafond Type C – Fracture above the level of the tibial plafond ANKLE FRACTURES – LAUGE-HANSEN CLASSIFICATION The first word in this classification denotes the position of the foot at time of injury. medial/lateral malleoli + posterior or anterior distal tibia. Intra-osseous ligament.Type II – Salter-Harris II Type III – Salter-Harris I Type IV – Salter-Harris III Type V – Salter-Harris IV Type VI – Open fx w/ removal of part of the physis. physis. This may also be seen in SER. Supination – Adduction I – transverse fx of the lateral malleolus II – vertical fx of the medial malleolus Pronation – Abduction I – Rupture of deltoid ligament/medial malleolar fx II – Rupture of ant inferior tibio-fibular ligament III – Bending fx of fibula 1cm proximal to plafond Pronation – Dorsiflexion I – Fx of medial malleolus II – Large anterior lip fx of tibia III – Fracture of superior lateral malleolus IV – Fracture of third malleolus (posterior tibia) Supination – External Rotation (SER) I – Rupture of ant inferior tibio-fibular ligament II – Spiral oblique fx of lateral malleolus (extending anterior inferior to posterior superior.) III – Rupture of post inferior tibio-fibular ligament IV – Deltoid rupture/fx of medial malleolus Pronation – External Rotation (PER) I – Rupture of deltoid ligament/medial malleolar fx II – Rupture of ant inferior tibio-fibular ligament. intra-osseous membrane III – Spiral fx above syndesmosis (high fibular fx) IV – Rupture of post inferior tibio-fibular ligament This injury typically causes diastasis – separation of the tibiofibular syndesmosis. extending to epiphysis B2 – Through epiphysis. and metaphysis DIAS-TACHDJIAN CLASSIFICATION Supination-Inversion – grade I (A) Supination-Inversion – grade II (B) Supination-Plantarflexion (C) Supination-Ext Rotation – grade I (D) Supination-Ext Rotation – grade II (E) Pronation-Eversion-Ext Rotation (F) Juvenile Tillaux Fracture (G) Triplanar Fracture (H) the leg. The numerical grades w/in each class occur each in chronological order and relate to the severity of trauma.
extra articular Type B .force thru 2nd ray: crushes middle 3rd w/ middle 3rd & tuberosity displaced medially A3 .TNJ displaces laterally w/ comminution of CCJ 4) Plantar Force (7%) Type A -avulsion fx of dorsal navicular or talus & ant process Type B .intra-articular injuries that are not displaced Type II .Moderate displacement & no comminution w/ significant dislocation of ankle joint Type 3.minimally displaced intra-articular fractures Type III . crush of inferior on x-ray 3) Lateral Force (17%) Type A . no comminution or impaction in articular or metaphyseal surface b. impaction involving supra-articular metaphysic c.impaction fracture of inferior CCJ 5) Crush Injury (6%) PILON FRACTURES – RUEDI & ALLGOWER CLASSIFICATION Type 1. Type II – Lateral fibular subluxation w/ plastic or angular deformity. severe comminution & displacement AO CLASSIFICATION (MUELLER) Type A . wedged between the tibia and fibula.moderately displaced intra-articular fx w/ several large fragments .FF forced into valgus w/ fx of navicular tuberosity or dorsal talus and compression fx of CCJ (Nutcracker fx) Type B .force thru 3rd ray: crushes lateral 3rd w/ medial 2/3 & tuberosity displaced medially Type B .completely articular All three can involve: a.force through 1st ray: crushes medial 3rd w/ tuberosity displaced medially A2 .medial displacement of FF w/ TN and CC joints Type C .maximally PF ankle giving a characteristic pattern of through and through navicular compression fracture A1 .partially articular Type C . w/o major disruption of ankle joint Type 2.FF rotates medially around interosseous talocalcaneal lig w/ TN disassociation and CCJ intact 2) Longitudinal Force (40%) worst prognosis of non-crush Type A .flake fx of dorsal talus or navicular and lateral calcaneus or cuboid Type B . comminution & impaction of articular surface with metaphyseal impaction OVADIA & BEALS CLASSIFICATION Type I .submaximally PF ankle resulting in dorsal displacement of superior navicular. CHOPART’S FRACTURES – MAIN & JOWETT 1) Medial Force (30%) precursor to STJ dislocation Type A .Explosion fx.Type I – Straight lateral subluxation of the fibula. w/ medial clear space on x-ray. due to interposition of delroid ligament.Mild to moderate displacement & no comminution. due to fibular microfracture Type III – Posterior rotatory subluxation of distal fibula behind talus w/ PITFL intact Type IV – Talus is dislocated superiorly.
mild weakness on heelraise test Stage II – Medial/lateral pain.external rotatory fx w/ large posterior fragment Type 3 . GIACOPELLI. talar tilt <15° PTTD – JOHNSON AND STROM Stage I – Medial pain. AND GRANOFF CLASSIFICATION Type I – Radioopacities found in the Achilles insertion – lesion is w/in tendon but attached to calcaneus Type II – Intratendinous opacities seen at the insertion 1-3cm proximal to bone.B.posterior marginal fx of tibia Subgroup II . CFL. + too many toes sign. weakness on heel raise. Lesions are clearly separated from calcaneus. >6cm gap TENDO-ACHILLES RADIOPAQUE LESIONS MORRIS.supra-articular fx w/ extension into ankle joint MAST SYSTEM Type 1 .C ANKLE SPRAINS – DIAS CLASSIFICATION Grade I – partial rupture of CFL Grade II – complete rupture of ATFL Grade III – complete rupture of ATFL. & PTFL RASMUSSEN CLASSIFICATION Stage I – rupture of ATFL Stage II – rupture of superficial fibers of PTFL Stage III – rupture of CFL Stage IV – rupture of deep fibers of PTFL HENRY CLASSIFICATION Group I – POP tender over ATFL. ant drawer -. w/o calcaneal involvement. + too many toes sign Stage III – Medial/lateral pain. tendon degeneration.malleolar fx w/ significant axial load at time of injury producing large posterior fragment Type 2 . flexed pes planus.rotational pattern consisting of 2 or more large tibial articular fragments. ant drawer +. wide longitudinal tears Stage III – Scarring in tendon. variable diameter. fixed pes planus. typically involving only partial thickness of tendon Type III – Lesions occur proximal to the insertion up to 412cm from attachment. tendon degeneration. ant drawer -. talar tilt <5° Group II – Moderate injury.ECKERT & DAVIS Grade I – retinaculum ruptured from cartilaginous lip to posterior lateral malleolus .spiral extension fx Type 3 . <3cm gap Type III – Complete rupture.compressive fracture pattern w/ multiple tibial fragments w/ marked anterior tibial cortical comminution MAALE & SELIGSON CLASSIFICATION Type 1 .explosion fx of tibia Subgroup IV . lateral ankle swelling and pain. no inversion on heel raise. flexible pes planus. longitudinal tears Stage II – Intramural degeneration. and/or PTFL Grade IV – complete rupture of all 3 lateral ligaments + partial rupture of deltoid ligament O’DONOGHUE CLASSIFICATION 1st Degree – ligament stretch w/ minimal disruption 2nd Degree – partial ligament disruption w/ joint instability 3rd Degree – complete ligament disruption LEACH CLASSIFICATION 1st Degree – partial or complete tear of ATFL 2nd Degree – partial or complete tear of ATFL & CFL 3rd Degree – partial or complete tear or ATFL.intra-articular w/ moderate displacement and large metaphyseal defects Group III – Severe injury. STJ arthritis MUELLER CLASSIFICATION Based on Etiology Type I – Direct injury Type II – Rupture secondary to systemic disease Type III – Idiopathic Type IV – Rupture secondary to mechanical dysfunction CONTI CLASSIFICATION (MRI) Stage I – One or two fine. POP over ATFL & CFL. ant drawer +. CFL.Type IV . talar tilt >15° Group IV – Chronic problem.severe comminution of both distal tibial metaphysis and articular surface KELLAM & WADDELL CLASSIFICATION Type A .anterior marginal fx of tibia Subgroup III . complete tear ROSENBERG CLASSIFICATION (MRI) Stage I – Hypertrophic tears in tendon (appears bulbous) Stage II – Atrophic tears Stage III – Complete tear ACHILLES RUPTURE – KUWADA CLASSIFICATION Type I – Partial rupture of tendon Type II – Complete rupture of tendon. Type IV – Partial tendon ossification or calcification Type V – Total tendon involvement PERONEAL TENDON DISLOCATION . tenosynovitis. no inversion on heel raise. 3-6cm gap Type IV – Complete rupture. talar tilt >15° STJ DISLOCATION – BUCKINGHAM Type I – Medial dislocation of STJ Type II – Lateral dislocation of STJ Type III – Anterior/posterior dislocation of STJ Type V .spiral fx from articular surface to metaphysis DESTOT SYSTEM Subgroup I . and a transverse/oblique fibular fracture at tibial plafond Type B .distal tibial compression fracture Type 2 .central compressive injury divided into A. minimal or no anterior comminution. + too many toes sign Stage IV – Medial/lateral pain. tendon elongation.
triple arthrodesis SHOTGUN WOUNDS – SHERMAN AND PARRISH Type I – Penetrates sub-Q or deep fascia. tx w/ resection or triple arthrodesis Ib – secondary arthritis. tx w/ triple or isolated arthrodesis IIb – secondary arthritis. Nievergelt-Perlman) Type II – mechanogenic infection IIa – implants. violating bone. Surgical I&D w/ abx will eradicate infection. Isloated Anomaly Ia – TC. subluxation. tx w/ resection.) Type II – Graze injury (abrasion. etc. tx w/ triple arthrodesis PERLMAN AND WERTHEIMER CLASSIFICATION Type I – Congenital coalition Type II – Acquired coalition TACHDJIAN CLASSIFICATION I. T-shaped Metatarsal Head C. Wide Metatarsal Head B. tx w/ resection or triple arthrodesis IIb – secondary arthritis. no phalangeal involvement Type IV – complicated. resulting in complete healing w/ no sequelae Type II – Delay in dx of 9-14 days. Complete Duplication TETAMY & MCKUSICK CLASSIFICATION Post-axial polydactyly only Type A – Complete digit that articulates w/ 5th MT head or duplicate 5th MT Type B – Accessory digit w/o osseous attachment BLAUTH & OLASON CLASSIFICATION Type A – Arrangement based on duplication distal to prox A1 – distal phalanx A3 – proximal phalanx A2 – middle phalanx A4 – metatarsal A5 – tarsal bone Type B – Transverse numbering of digits medial to lateral SYNDACTYLY – DAVIS & GERMAN Type I – incomplete webbing between digits Type II – complete webbing to ends of digits Type III – simple syndactyly. tx w/ triple arthrodesis Type II – intra-articular coalition IIa – no secondary arthritis. tx w/ badgley procedure Ib – secondary arthritis. or NC Ib – multiple combinations of Ia Ic – massive tarsal coalition Type VI – Perforating/through & through (A-E above) Type VII – Penetration w/ missile embolization PUNCTURE WOUNDS – GREEN & BRUNO Type I – Early dx w/ surgical I&D and appropriate antibiotic coverage. Y-shaped Metatarsal Head D. Juvenile (Osseous Immaturity) Type I – extra-articular coalition Ia – no secondary arthritis. Adult (Osseous Maturity) Type I – extra-articular coalition Ia – no secondary arthritis. due to blood spatter) Type I – Blunt injury (non-penetrating due to vest.Grade II – distal 1-2cm fibrous lip of malleolus is elevated w/ retinaculum Grade III – a thin fragment of bone w/ cartilage is avulsed from deep surface of peroneal retinaculum & deep fascia Type I – Hematogenous osteo Type II – Osteo secondary to contiguous source Type III – Osteo assoc w/ vascular insufficiency Type IV – Chronic osteo PATZAKIS CLASSIFICATION Zone I – Distal metatarsal neck (most common) Zone II – MT neck to MTJ (least common) Zone III – calcaneus or talus TARSAL COALITIONS – DOWNEY A. injury to superficial dermis) Type III – Blast effect w/o missile penetration (near miss) Type IV – Blast effect w/ missile penetration Type V – Penetrating injury A – Laceration of dermis D – Body cavity B – Sub-Q C – Deep Tissues E – More than one body region Type II – intra-articular coalition IIa – no secondary arthritis. Associated w/ Major Limb Abnormalities POLYDACTYLY – VENN & WATSON A. synphalangism) IIb – manifestation of a syndrome (Apert’s. from distance greater than 7 yards Type II – Occurs at 3-7 yards. resulting in chronic infection. joint deformity Type III – Delay in dx more than 2 weeks. Digital Duplication E. Part of Complex Malformation IIa – assoc w/ other synostoses (carpal coalition. necessitates bone resection OSTEOMYELITIS – BUCKHOLZ Type I – wound induced osteomyelitis Ia – open fx w/ complete discontinuity Ic – post-op infection Ib – penetrating wound II. internal fixation IIb – contact instability/bone on bone apposition Type III – physeal osteomyelitis Type IV – ischemic limb disease Type V – combination osteo of types I-IV Type VI – osteitis from septic arthritis Type VII – chronic osteomyelitis CIERNY-MADER CLASSIFICATION Type I – medullary osteo Type II – superficial osteo Type III – localized osteo Type IV – diffuse osteo Type A – good immune system and vascularity Type B – local or systemic immune compromise Type C – tx will be more harmful to patient than disease WALDVOGEL CLASSIFICATION III. and osteochondral fragmentation Stage II – coalescence. viscera. absorption of debris and fusion of larger fragments to adjacent bone . phalangeal bones appear abnormal CHARCOT FOOT – EICHENHOLTZ Stage I – destructive phase w/ joint laxity. tx w/ triple arthrodesis B. CN. possibly w/ residual bone. shoe. CC. and vascular system Type III – Occurs at <3 yards. blast injury w/ severe local destruction of all tissues ORDOG CLASSIFICATION Type 0 – No injury (suspicion of injury.
articular cartilage intact ND . REFLEX SYMPATHETIC DYSTROPHY Stage I – ST edema. Type III – Significant exostosis w/ or w/o fragmentation. degeneration of articular cartilage. or bone Grade 3 – wound penetrating to bone or joint Type A – Clean. regrowth w/ fusiform swelling 4th Degree – incomplete severance of nerve 5th Degree .K. osteomyelitis) Grade 4 – Partial gangrene in the forefoot Grade 5 – Entire foot is gangrenous. loss of articular cartilage Type IV – epiphyseal dysplasia. resulting in partial severance of nerve Neurotmesis – complete severance of nerve. proliferative/destructive joint change Flattening of 1st MT head. capsule or bone Grade 2 – wound penetrating to capsule. after 3-4wks see spotty osteoporosis on X-ray. periarticular lipping or phalanx base and 1st MT head Grade III. ORLOFF. flattening of MT head. limited ROM on WB but normal NWB Stage II – Joint adaptation Pain on end ROM. joint stiffness. ischemic wound Type D – Infected. established arthrosis Severe flattening of 1st MT head. dorsal & lateral osteophytes Grade IIb – Grade IIa + subchondral sclerosis & cysts Grade III – Grade IIa + severe 1st MT head flattening. periarticular spurring.A. erosions. dirty or clean Grade 2 – Deeper lesion involving tendon. revascularization and remodeling of bone and fragments ANTERIOR TIBIOTALAR SPURS – MCDERMOTT & SCRANTON Type I – Synovial impingement. severe spotty osteoporosis (Sudek’s atrophy). assoc inflammatory arthritis Grade IV – Ankylosis/Hallux Rigidus Obliteration of joint space w/ loss of majority of articular surface.Joint deterioration/arthritis. small dorsal osteophyte Stage III – Joint deterioration Crepitus on ROM. tendon. ischemic wound MEADE & MUELLER CLASSIFICATION Type 1 – Dorsal foot phlegmon (non-localized cellulitis) Type 2 – Deep plantar space infection Type 3 – Mal perforans diabetic foot ulcer Grade II – Adaptation. flattening of MT head. Type II – periarticular spurs. narrowing of joint space. non-uniform joint space narrowing. flattening of 1st MT head. marked involvement of sesamoids MODIFIED REGNAULD/ORLOFF CLASSIFICATION Stage I – Functional hallux limitus No DJD. vascular wound Type B – Infected. osteophytes. joint ROM normal NWB. large or small. reluctant movement. osteochondral defect/cartilage fibrillation & erosion. confirmed w/ DF stress views. no open lesions. X-rays show inflammatory reaction. Grade 1 – Skin only lesion. deformity. joint mice. crepitus. articular cartilage intact Type III – severe DJD. osteophyte fragmentation. pronounced pain w/ guarding. diffuse osteoporosis. no DJD. enlargement of joint. marked hypertrophy of joint. less than 10° ROM. loss of ROM. X-rays show osseous spur formation >3mm. joint fibrosis. non-uniform narrowing of joint space. minimal to no ROM HANFT CLASSIFICATION Grade I – MPE. Type II – Osteochondral reaction exostosis. cyanotic skin Stage III – 6-9 mos. Stage II – (approx 3mos). osteophytosis dorsally. sesamoid hypertrophy Grade IV – Grade III + subchondral sclerosis & cysts AVN OF THE 2 METATARSAL – FREIBERG Type I – no DJD. arthritic changes. redness. creptius. no sesamoidal dz 2nd Degree – Arthrosis. heat. or posterior degenerative. or bone Grade 3 – Grade 2 w/ infection (abscess. hyperextension of HIPJ. hyperhidrosis. pain on ROM. osteophytosis. pain. subchondral cysts. w/ wallerian degeneration distal to the point of injury 3rd Degree – fibrosis of nerve. not involving tendon. loss of joint space. Increased anterior ST swelling. little or no ROM. subchondral sclerosis and cyst formation. painful ROM. multiple head involvement AVN OF TH 2 METATARSAL – KATCHERIAN Level A – fissures noted in distal metaphysis or epiphysis Level B – increased fissuring w/ bone resorbtion Level C – increased fissuring w/ central collapse of MT head Level D – collapse & fx w/ fragments on either side of joint Level E – complete collapse of MT head ND COMPLEX REGIONAL PAIN SYNDROME CLASSIFICATION A. lateral. plantar subluxation of proximal phalanx. crepitus. epithelialized Grade 1 – superficial wound. subchondral eburnation. mild dorsal exostosis. periarticular spurring. no procedures possible UTSA CLASSIFICATION Grade 0 – pre or post ulcerative lesion. MRI confirms osteoblastic and chondral hyperplastic reaction. brawny edema. pronatory architecture. flattening of MT head. no pain on end ROM. AND JACOBS Grade I – Functional limitus Hallux equinus/flexus. pain at end ROM. tight-appearing and wax-like skin. but is limited on WB. muscle. passive ROM limited. resulting in pinpoint segmental demyelination Axonotmesis – severance of individual nerve fibers. HALLUX LIMITUS/RIGIDUS – DRAGO. dry. up to 3mm spur formation. severe flatting of 1st MT head Stage IV – Ankylosis Obliteration of joint space. cool. exuberant osteophytosis w/ joint mice. Type IV – Pan-talocrural arthritic destruction. disability NERVE INJURY – SEDDEN Neuropraxia – interruption of nerve impulse due to extrinsic pressure. pain on end ROM. resulting in wallerian degeneration SUNDERLAND CLASSIFICATION 1st Degree – disruption of nerve impulses w/o wallerian degeneration 2nd Degree – disruption of axon.Stage III – remodeling.complete severance of nerve FOOT ULCERATION – WAGNER Grade 0 – Skin is intact. sesamoid hypertrophy 3rd Degree – Ankylosis. small dorsal exostosis. MPE. 2° spur formation on the talus w/ fragments. 1st MPJ sclerosis Grade IIa –Grade I +. joint space narrowing. hyperesthesia to light touch. narrowing of joint space. X-rays suggest medial. vascular wound Type C – Clean. malalignment REGNAULD CLASSIFICATION 1st Degree – Limitation of 1st MPJ ROM to 40°.
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Med.31:103-18 Epiphyseal Fractures – Dias Tachdjian Dias LS. Helv Chir Acta. and results in fractures of the os calcis. no blisters 2nd Degree – superficial or deep. Lateral Malleolar Fracture – Danis-Weber Danis R. 16:190-198 th 5 Metatarsal Fractures – Torg Torg J. supination-dorsal flexion fracture. Etude Sur les luxations du metatarse. Freeman P: Fractures of os calcis . Results using a prognostic computed tomography scan classification. 4th ed. Bern. Morrey BF. Wien. Stuttgart. 60:957-85 . Acta Orthop Scand 48: 317-324. DiPasquale T: Operative treatment in 120 displaced intraarticular calcaneal fractures. Osteosynthesis dislozierter intraartikularer calcaneusfrakturen. Vol 2. Orthopedics 1990. Lippincott. Clin Orthop 1993 May. 6th Ed. 41: 7-18 Epiphyseal Fractures – Peterson Peterson HA: Physeal & apophyseal injuries.75mm 83-100% Level 2 – 0. 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