Müller AO Classification of Fractures—Long Bones

This leaflet is designed to provide an introduction to the classification of long-bone fractures.

metaphyseal multifragmentary articular multifragmentary . metaphyseal simple articular simple.1 11-A1 Humerus 11 proximal (types according to topography and extent of bone lesion) 11-A2 11-A3 11-B1 11-B2 11-B3 11-C1 11-C2 11-C3 11-A 11-A1 11-A2 11-A3 extraarticular unifocal fracture tuberosity impacted metaphyseal nonimpacted metaphyseal 11-B 11-B1 11-B2 11-B3 extraarticular bifocal fracture with metaphyseal impaction without metaphyseal impaction with glenohumeral dislocation 11-C 11-C1 11-C2 11-C3 articular fracture with slight displacement impacted with marked displacement dislocated 12 diaphyseal 12-A1 12-A2 12-A3 12-B1 12-B2 12-B3 12-C1 12-C2 12-C3 12-A 12-A1 12-A2 12-A3 simple fracture spiral oblique (> 30°) _ transverse (< 30°) 12-B 12-B1 12-B2 12-B3 wedge fracture spiral wedge bending wedge fragmented wedge 12-C 12-C1 12-C2 12-C3 complex fracture spiral segmental irregular 13 distal 13-A1 13-A2 13-A3 13-B1 13-B2 13-B3 13-C1 13-C2 13-C3 13-A 13-A1 13-A2 13-A3 extraarticular fracture apophyseal avulsion metaphyseal simple metaphyseal multifragmentary 13-B 13-B1 13-B2 13-B3 partial articular fracture sagittal lateral condyle sagittal medial condyle coronal 13-C 13-C1 13-C2 13-C3 complete articular fracture articular simple.

radius intact radius fractured. palmar rim 23-C 23-C1 23-C2 23-C3 complete articular fracture of radius articular simple. other artic. radius simple radius complex. ulna intact both bones 21-B 21-B1 21-B2 21-B3 articular fracture ulna fractured. multifragmentary 23-B 23-B1 23-B2 23-B3 partial articular fracture of radius sagittal coronal. simple and impacted radius. ulna intact one bone articular fracture. multifragmentary multifragmentary 22 22-A1 diaphyseal 22-A2 22-A3 22-B1 22-B2 22-B3 22-C1 22-C2 22-C3 22-A 22-A1 22-A2 22-A3 simple fracture ulna fractured. dorsal rim coronal. other extraarticular 21-C 21-C1 21-C2 21-C3 articular fracture of both bones simple one artic. ulna simple both bones complex 23 23-A1 distal 23-A2 23-A3 23-B1 23-B2 23-B3 23-C1 23-C2 23-C3 23-A 23-A1 23-A2 23-A3 extraarticular fracture ulna fractured. radius intact radius fractured. simple. radius intact radius fractured. radius intact radius. other simple or wedge 22-C 22-C1 22-C2 22-C3 complex fracture ulna complex. metaphyseal simple articular simple. radius intact radius fractured.2 21 21-A1 Radius/ulna proximal 21-A2 21-A3 21-B1 21-B2 21-B3 21-C1 21-C2 21-C3 21-A 21-A1 21-A2 21-A3 extraarticular fracture ulna fractured. ulna intact one bone wedge. metaphyseal multifragmentary articular multifragmentary . ulna intact both bones 22-B 22-B1 22-B2 22-B3 wedge fracture ulna fractured.

metaphyseal simple artic.1 = subtrochanteric fracture 33 distal 33-A1 33-A2 33-A3 33-B1 33-B2 33-B3 33-C1 33-C2 33-C3 33-A 33-A1 33-A2 33-A3 extraarticular fracture simple metaphyseal wedge and/or fragmented wedge metaphyseal complex 33-B 33-B1 33-B2 33-B3 partial articular fracture lateral condyle.1 = subtrochanteric fracture 32-B wedge fracture 32-B1 spiral wedge 32-B2 bending wedge 32-B3 fragmented wedge 32-B(1–3). trochanteric area pertrochanteric simple pertrochanteric multifragmentary intertrochanteric 31-B 31-B1 31-B2 31-B3 extraarticular fracture. sagittal coronal 33-C 33-C1 33-C2 33-C3 complete articular fracture articular simple. neck subcapital. metaphyseal multifragmentary articular multifragmentary . displaced.1 = subtrochanteric fracture 32-C complex fracture 32-C1 spiral 32-C2 segmental 32-C3 irregular 32-C(1–3). sagittal medial condyle. nonimpacted 31-C 31-C1 31-C2 31-C3 articular fracture. with slight displacement transcervical subcapital. head split (Pipkin) with depression with neck fracture 32 32-A1 diaphyseal 32-A2 32-A3 32-B1 32-B2 32-B3 32-C1 32-C2 32-C3 30° 32-A simple fracture 32-A1 spiral 32-A2 oblique (> 30°) _ 32-A3 transverse (< 30°) 32-A(1–3). simple.3 31 31-A1 Femur proximal (defined by a line passing transversely through the lower end of the lesser trochanter) 31-A2 31-A3 31-B1 31-B2 31-B3 31-C1 31-C2 31-C3 31-A 31-A1 31-A2 31-A3 extraarticular fracture.

metaphyseal multifragmentary articular multifragmentary 42 42-A1 diaphyseal 42-A2 42-A3 42-B1 42-B2 42-B3 42-C1 42-C2 42-C3 42-A 42-A1 42-A2 42-A3 simple fracture spiral oblique (> 30°) _ transverse (< 30°) 42-B 42-B1 42-B2 42-B3 wedge fracture spiral wedge bending wedge fragmented wedge 42-C 42-C1 42-C2 42-C3 complex fracture spiral segmental irregular 43 distal 43-A1 43-A2 43-A3 43-B1 43-B2 43-B3 43-C1 43-C2 43-C3 43-A 43-A1 43-A2 43-A3 extraarticular fracture simple wedge complex 43-B 43-B1 43-B2 43-B3 partial articular fracture pure split split-depression multifragmentary depression 43-C 43-C1 43-C2 43-C3 complete articular fracture articular simple. simple. simple.4 41 41-A1 Tibia/fibula proximal 41-A2 41-A3 41-B1 41-B2 41-B3 41-C1 41-C2 41-C3 41-A 41-A1 41-A2 41-A3 extraarticular fracture avulsion metaphyseal simple metaphyseal multifragmentary 41-B 41-B1 41-B2 41-B3 partial articular fracture pure split pure depression split-depression 41-C 41-C1 41-C2 41-C3 complete articular fracture articular simple. metaphyseal simple artic. metaphyseal multifragmentary articular multifragmentary . metaphyseal simple artic.

aofoundation.1 . simple fibular diaphyseal fracture. multifragmentary proximal fibular lesion Copyright © 2007 by AO Publishing.org/legal 44-B 44-B1 44-B2 44-B3 transsyndesmotic fibular fracture isolated with medial lesion with medial lesion and Volkmann‘s fracture AOE-E1-018. Switzerland Check hazards and legal restrictions on www.44 malleolar segment 44-A1 44-A2 44-A3 44-A 44-A1 44-A2 44-A3 infrasyndesmotic lesion isolated with fractured medial malleolus with posteromedial fracture 44-B1 44-B2 44-B3 44-C1 44-C2 44-C3 44-C 44-C1 44-C2 44-C3 suprasyndesmotic lesion fibular diaphyseal fracture.

1 . .3 3 subgroups 2 diaphyseal B wedge fracture 2 bending wedge 2223- 3162- 32113. distal = 3) Alphanumeric structure of the Müller AO Classification of Fractures—Long Bones for adults 919.2 . diaphyseal = 2.Femur/patella 3334411222427.Pelvis/acetabulum Example 32-B2 3 femur 141515. Anatomical location is designated by two numbers: one for the bone and one for its segment (ulna and radius as well as tibia and fibula are regarded as one bone). The proximal and the distal segments of long bones are defined by a square whose sides have the same length as the widest part of the epiphysis (exceptions 31.Spine 1353212.and 44-).Foot Anatomical location of the fracture.Hand 2141- 42- 4.Craniomaxillofacial bones 925152111.Clavicula 14.Tibia/fi bula 1323334344- 4344- 8.AO/OTA system for numbering the anatomical location of a fracture in three bone segments (proximal = 1.Scapula Bone 1234 4 long bones Localization Diagnosis = “essence” of the fracture Segment 1 2 3 (4) 3 or 4 segments 3132- Morphology Type ABC 3 types Group 123 3 groups Subgroup .Radius/ ulna 616.Humerus 125. The malleolar segment (44-) is an exception.

proximal femur (31-). main fragments have no contact after reduction Extraarticular No involvement of displaced fractures extending into the articular surface Partial articular Part of the articular component is involved. metaphyseal fracture completely separates articular component from the diaphysis 2 Diaphyseal Simple One fracture line. main fragments have contact after reduction Complex Three or more fragments.Definitions of fracture types for long-bone fractures in adults Exception to this are fractures of the proximal humerus (11-). malleoli (44-). cortical contact between fragments exceeds 90% after reduction 3 Distal Wedge Three or more fragments. metaphyseal fracture completely separates articular component from the diaphysis . leaving the other part attached to the meta-/diaphysis Complete articular Articular surface involved. leaving the other part attached to the meta-/diaphysis Complete articular Articular surface involved. subtrochanteric fractures (32-) Segment A 1 Proximal Type B C Extraarticular No involvement of displaced fractures extending into the articular surface Partial articular Part of the articular component is involved.

simple transverse (X2-A3). bending wedge (X2-B2). fragmented wedge (X2.Steps in identifying diaphyseal fractures Classification of fractures of the diaphysis into the three fracture groups. or a spiral fragmented complex fracture (X2-C1) Bending forces produce simple oblique (X2-A2).B3). Diaphyseal fracture Step 1 2 Question Which bone? Is the fracture at the end or in the middle segment of the bone? Type: Is the fracture a simple or multifragmentary one (does it have > 2 parts)? Is there contact between both fracture ends or not? Answer Specific bone (X) Middle segment (X2) Type 1 A Simple Group 2 3 3 Simple (X2-A) If it is multifragmentary. a spiral wedge (X2-B1). or complex (X2C3) fractures C2 fractures are segmental by definition Spiral C Complex Bending Multifragmentary Spiral Segmental Irregular . go to step 3a If there is contact it is a wedge (X2-B) If there is no contact it is complex (X2-C) 3a Spiral B Wedge Oblique Transverse 4 Group: Is the fracture pattern caused by a twisting (spiral) or bending force? Spiral or twisting forces will result in a simple spiral (X2-A1).

go to step 4b Simple Wedge Complex 4a 4b Type: Is it partial or total articular? If part of the joint is still attached to the meta-/diaphysis it is partial articular (XX-B) If it is not attached to the diaphysis it is complete articular (XX-C) B Partial articular 5 Group: How many fracture lines cross the joint surface? If there is one line it is simple If there are > 2 lines it is multifragmentary Simple: extraarticular (XX-A1). simple metaphyseal Simple articular.Steps in identifying end segment fractures Classification of fractures of the end segment into the three fracture groups End segment fracture Step 1 2 Question Which bone? Is the fracture at the end or middle segment of the bone? Is the fracture through the proximal or distal end segment? Type: Does the fracture enter the articular surface? Answer Specific bone (X) End segment Type 1 A Extraarticular Group 2 3 3 Proximal (X1) Distal (X3) If it does not enter it is extraarticular (XX-A). go to step 6 If it enters it is articular. or complex articular (XX-C3) C Articular Depression Split-depression 6 Group: How is the metaphysis fractured? Simple articular. complex metaphyseal Complex articular. or simple articular (XX-C1) Split Wedge: extraarticular (XX-A2) Complex: extraarticular (XX-A3). or simple articular (XX-C2). complex metaphyseal .

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