Clasificacion AO

Journal ofOrthopaedjc Trauma
Vol. 10, Suppl. I, pp. 1-155

@ 1996 Lippincott-Raven Publishers, Philadelphia
Fracture and Dislocation Compendium
Orthopaedic Trauma Association

Committee for Coding and Classification
HUMERUS
BONE: Location: Types:

HUMERUS (1) Proximal segment (11) A. Extra-articolar, onifocal frac-
tore (ll-A)
-
B. Extra-articular, bifocal frac-

tore (ll-B)
C.Articular fractures (11-C)
1
2 HUMERUS
Groups:
Humerus proximal segment, extra- Humerus, proximal segment, extra- Humerus, proximal segment, ar-
articularunifocal (ll-A) articular, bifocal (11-B) ticular fractures ( ll-C)
1. Avulsion of tuberosity (11-Al) I. With metaphyseal impaction 1. Articular fracture with slight
(11-Bl) displacement impacted valgus
fracture ( ll-C 1)
2. Impacted metaphysis (11-A2)

2. Without metaphyseal im-
2.Articular fracture impactedwith
paction (11-B2)
marked displacement (11-C2)
3. Non-irnpacted metaphysisfrac-
tore (11-A3)
3. Articular fracture with gleno-
humeral dislocation (11-C3)
3. With glenohumeral dislocation
(11-B3)
These fractures represent three part

fractures, or fracture dislocations
as by the Neer classification.
A B c
J Orthap Trauma, Val. 10, Suppl. 1, 1996
HUMERUS 3
Subgroups and Qualifications:

Humerus, proximal, extra-articular, Humerus,proximal, extra-articular Humerus, proximal, articular frac-
unifocal tuberosity (ll-Al ) bifocal, with metaphysealimpaction ture with slight displacement
I. Greater tuberosity not dis- (ll-Bl) (11-Cl)
placed (ll-Al.l) I. Lateral plus greater tuberosi- I. Cephalotubercular with valgus
ty(ll-Bl.l) malalignment (ll-Cl.l)
(1) pure lateral impaction
(2) posterior and lateral impaction
(3) anterior and lateral impaction
2. Greater tuberosity, displaced

2. Cephalotubercular with varus
(11-Al.2)
malalignment (11-Cl.2)
(1) superior, (2) posterior
2. Medial plus lesser tuberosity

(11-Bl.2)
( 1) pure lateral impaction
(3) anterior and lateral impaction
3. Anatomical neck (11-Cl.3)

(1) nondisplaced
3. With glenohumeral dislocation
(2) displaced
(11-Al.3)
(1) anterior and medial plus poste-
rior cephalic notch
(2) anteriorand medial plus greater
tuberosity
(3) erectaand greatertuberosity
3. Posterior plus greater tuberos-
(4) posterior and lessertuberosity
ity (11-Bl.3)
At Bl Cl
J Orthap 1rauma, Val. 10, Suppl. 1, 1996

4 HUMERUS
Humerus, proximal, extra-articu- Humerus, proximal, extra-articular Humerus,proximal, articular frac-

lar, unifocal, impacted metaphy- bifocal, without metaphyseal im- ture impacted with marked dis-
seal (11-A2) paction (11-B2) placement(I I-C2)
I. Without frontal malalignment I. Without rotatory displacement I. Cephalotubercular with valgus
(11-A2.1) of the epiphyseal fracture frag- malalignment (11-C2.1)
(1) without sagittal malalignment ment (11-B2.l )
(2) posterior impaction
(3) anterior impaction
2. Cephalotubercular with varus
malalignment (11-C2.2)
2. With rotatory displacement of
2. With varus malalignment the epiphyseal fragment (11-B2.2)
(11-A2.2) (1) greater tuberosity separated
(1) pure medial impaction (2) lesser tuberosity separated
(2) posterior and medial impaction
(3) anterior and medial impaction
3. Transcephalic (double profile

image on x-ray) and tubercular,
with varus malalignment( ll-C2.3 )
3. Multifragmentary metaphysis
3. With valgus mal alignment
plus one of the tuberosities
(11-A2.3)
( I) pure lateral impaction (11-B2.3)
( 1) lesser tuberosity
(3) anterior and lateral impaction (2) greater tuberosity
A2 B2 C2
J Orthap Trauma. Val. 10. Suppl. 1996
HUMERUS 5
Humerus,proximal, extra-articular Humerus,proximal, extra-articular Humerus,proximal, articular frac-

unifocal, non-impacted metaphy- bifocal with glenohumeraldisloca- ture, dislocated(11-C3)
seal (11-A3) tion (11-B3) 1. Anatomical neck (11-C3.1)
I. Simplewith angulation(ll-A3.l) I. "Vertical" cervical line plus (1) anterior
greater tuberosity intact plus an- (2) posterior
tenor medial dislocation(ll-B3.1 )
2. Simple with translation (11-A3.2)

(1) lateral 2. Anatomical neck and tuberosi-
(2) medial 2. "Vertical" cervical line plus ties (11-C3.2)
(3) with glenohumeral dislocation greatertuberosityfracture plus an- (1) head impacted
tenor medial dislocation(11-B3.2) (2) head not impacted
3. Multifragmentary (11-A3.3)
(1) wedge 3. Lesser tuberosity fracture plus
(2) complex posterior dislocation (11-B3.3)
3. Cephalotubercular fragmen-
(3) glenohumeral dislocation (1) without anterior cephalicnotch
tation (11-C3.3)
(2) with anterior cephalic notch
(1) head intact
(2) head fragmented
A3 B3 C3
JOrthaD Trauma. Val. ]0. SuDDI. ]. ]996

6 HUMERUS

HUMERUS (I) Diaphyseal segment(12) A. Simple fracture (12-A)
--~
" ,
I ,
..i,:~jJ
B. Wedge fracture (12-B)
c. Complex fracture (12-C)

HUMERUS
Groups:
Humerus diaphyseal, simple (12-A) Humerus diaphyseal, wedge (12-B) Humerus diaphyseal, complex
I. Spiral (12-Al) I. Spiral wedge (12-Bl) (12-C)
I. Spiral (12-CI)
2. Oblique (? 300) (12-A2) 2. Bending wedge (12-82)
2. Segmental (12-C2)
3. Transverse «300) (12-A3)

3. Fragmented wedge (12-B3)
3. Irregular (12-C3)
A B c
J Orthop Trauma, Vol. 10, Suppl. 1, 1996
8 HUMEI:<US

Humerus diaphyseal, simple, spi Humerusdiaphyseal,wedge,spiral Humerusdiaphyseal,complex spi-
ral (12-Al ) (12-Bl) ral (12-Cl)
1. Proximal zone (12-Al.l ) I. Proximal zone (12-Bl.l) ( 1) pure diaphyseal
(2) proximal diaphysio-metaphyseal
(3) distal diaphysio-metaphyseal
I. With two intermediate frag-
ments (12-Cl.l)
2. Middle zone (12-Al.2)
2. Middle zone (12-Bl.2)
2. With three intermediate frag-

ments (12-Cl.2)
3. Distal zone (12-AI.3)
3. Distal zone (12-Bl.3) 3. With more than three inter-

mediate fragments (12-Cl.3)
At Bl Cl
J Orthop Trauma, Val. 10, Suppl. 1, 1996

HUMERUS 9
Humerus diaphyseal, simple, Humerus diaphyseal, wedge, bend- Humerusdiaphyseal,complex seg-

oblique (>300) (12-A2) ing (12-82) mental (12-C2)
1. Proximal zone (12-A2.1) I. Proximal zone (12-82.1) I. With one intermediate seg-
mental fragment (12-C2.1)
(1) pure diaphyseal
(4) oblique lines
(5) transverseand oblique lines
2. Middle zone (12-A2.2)

2. Middle zone (12-B2.2)
2. With one intermediate seg-

mental and additional wedge
fragments (12-C2.2)
( 1) pure diaphyseal
(4) distal wedge
(5) two wedges, proximal and distal
3. Distal zone (12-A2.3)
3. Distal zone (12-B2.3)
3. With two intermediate seg-

mental fragments (12-C2.3)
(1) pure diaphyseal
A2 B2 C2
J Orthap Trauma, Val. 10, SuppL I, 1996

10 HUMERUS
Humerus diaphyseal, simple, trans- Humerus diaphyseal, wedge, frag- Humerus diaphyseal, complex ir-
verse «300) (12-A3) mented (12-B3) regular (12.C3)
I. Proximal zone (12-A3.1) I. Proximal zone (12-B3.1) I. With two or three intermedi-
ate fragments (12-C3.1 )
(I) two main internlediate fragments
(2) three main intermediate frag-
ments

2. With limited shattering «4cm)

(12-C3.2)
(1) proximal zone
(2) middle zone
(3) distal zone
3. With extensive shattering

(>4cm) (12-C3.3)
(1) pure diaphyseal
A3 B3 C3
J Orthov l)-auma. Vol. 10. Suvvl. 1. 1996
HUMERUS 11

HUMERUS (I) Distal segment (13) A. Extra-articular fracture (13-A)
B. Partial articular fracture (13-B)
C. Complete articular fractures

(13-C)

12 HUMERUS
Groups:
Humerus, distal segment, extra-ar- Humerus, distal segment, partial ar- Humerus,distal segment,complete
ticular (13-A) ticular (13-B) articular (13-C)
1. Apophyseal avulsion (13-Al) 1. Lateral sagittal (13-Bl) 1. Articular simple, metaphyseal
simple (13-CI)
2. Medial sagittal (13-B2)

2. Articular simple, metaphyseal
2. Metaphyseal simple (13-A2)
multifragmentary ( 13-C2)
~.
rl\ I
} , (
3. Frontal (13-B3)
3. Metaphyseal multifragmentary
3. Articular, metaphyseal multi-
(13-A3)
fragmentary (13-C3)
A B c
HUMERUS 13

Humerus, distal, extra-articular Humerus, distal, partial articular, lat- Humerus,distal complete,articular
apophyseal avulsion (13-Al) eral sagittal (13-Bl) simple,metaphysealsimple(13-Cl)
I. Lateral epicondyle (13-Al.l) I. Capitellum (13-Bl.l) 1. With slight displacement
(1) through the capitellum (Milch I) (13-Cl.l)
(2) between capitellum and trochlea (1)Y-shaped
(2) T-shaped
(3) V-shaped
2. Medial epicondyle, non-incar-

cerated (13-Al.2)
2. Transtrochlear simple (13-Bl.2)
(1) non-displaced (1) medial collateral ligament intact
(2) displaced (2) medial collateral ligament rup- 2. With marked displacement
(3) fragmented tured (13-Cl.2)
(3) metaphyseal simple (classic (l)Y-shaped
Milch II) lateral condyle (2) T-shaped
(4) metaphyseal wedge (3) V-shaped
(5) metaphysio-diaphyseal
..lJJl
~~j~ y
3. Medial epicondyle, incarcerat- , I I I
ed (13-Al.3)
3.T-shaped epiphyseal (13-Cl.3)

3. Transtrochlear multifragmen-
tary (13-Bl.3)
( l) epiphysio-metaphyseal
(2) epiphysio-metaphyseal-diaphy-
seal
r~lr '
\ [I I
I I
r 11- ,J
, J\ 1
I I I'
At Bl Cl
J Orthap Trauma, Val. 10, Suppl. I, 1996

14 HUMERUS
Humerus, distal, extra-articular meta- Hwnerus, distal, partial articular, me- Humerus, distal, complete articular
physeal simple (13-A2) dial sagittal (13-82) simple metaphyseal multifragmen-
I. Oblique downwards and in- I. Transtrochlear simple, through tary (13-C2)
wards (13-A2.1) medial side (Milch 1} (13-82.1) I. With intact wedge (13-C2.1)
(I) metaphyseal lateral
(2) metaphyseal medial
(3) metaphysio-diaphyseallateral
(4) metaphysio-diaphyseal medial
2. Oblique downwards and out-

wards (13-A2.2)
,;
2. Transtrochlear simple, through -.-,r )
\ J\ I
the groove(13-B2.2) IIi I
2. With a fragmented wedge

(13-C2.2)
(I) metaphyseallateral
3. Transverse (l3-A2.3) (2) metaphyseal medial
(l)transmetaphyseal (3) metaphysio-diaphyseallateral
(4) metaphysio-diaphyseal medial
3. Transtrochlear multifragmen-
tary (13-B2.3)
(I) epiphysio-metaphyseal
(2) epiphysio-metaphyseal-diaphy-
seal -
(2) juxta-epiphyseal with posterior ,...,r -l
\ Il I
displacement (Kocher I) I I J ,
3. Complex (13-C2.3)
(.;;. -j
, (\ I
(3) juxta-epiphyseal with anterior dis- , I ,
placement (Kocher II)
A2 B2 C2
HUMERUS ]5
Humerus, distal, extra-articular meta- Humerus, distal, partial articular, Humerus, distal, complete multi-
physeal multifragmentary (13-A3) frontal (13-B3) fragmentary (13-C3)
1. With intact wedge (13-A3.l) I. Capitellum (13-B3.1) 1. Metaphyseal simple (13-C3.l)
( 1) lateral (I) incomplete (Kocher-Lorenz)
(2) medial (2) complete (Hahn-Steinthal 1)
(3) with trochlear component
(Hahn-Steinthal 2)
(4) fragmented
'-~ 1
\ R I
, ,I f
2. Metaphyseal wedge (13-C3.2)

(1) intact
2. With fragmented wedge (2) fragmented
(13-A3.2)
(I) lateral
(2) medial
2. Trochlea (13-B3.2)
(1) simple
(2) fragmented
3. Metaphysealcomplex (13-C3.3)
(1) localized
(2) extending into diaphysis
3. Complex (13-A3.3)
3. Capitellum and trochlea
(13-B3.2)
A3 B3 C3
JOrthap Trauma, Val. 10, Suppl. 1,1996

16 RADIUS/ULNA
RADIUS/ULNA
BONE: Location: Types :

RADIUS/ULNA (2) Proximal segment (21) A. Extra-articular (21-A)
B. Articular fracture involving ar-

ticular surface of only one of the
two bones (21-B)
c. Articular fracture involving

articular surface of two bones
(21-C)

RADIUS/ULNA 17
Groups:
Radius/Ulna, proximal, extra-ar- Radius/Ulna, proximal, articular Radius/Ulna, proximal, articular
ticular (2l-A) surfaceone bone (2l-B) both bones(21-C)
1. Ulna only (21-AI) I. Ulna fractured, radius intact I. Simple of both bones (21-Cl)
(2l-Bl)
2. Radius only (21-A2) 2. Radius fractured, ulna intact 2. Simple of one, multifragmen-
(21-B2) tary of other (21-C2)
3. Radius and ulna (21-A3)

3. Articular of one bone, extra-
3. Multifragmentary of both
articular of other (21-B3)
(21-C3)
A B c
18 RADIUS/ULNA

Radius/Ulna, proximal, extra-ar- Radius/Ulna, proximal, articular Radius/Ulna, proximal, articular
ticular ulna fractured (21-Al) fracture ulna (21-Bl) both simple (21-Cl)
I. Avulsion of triceps insertion I. Unifocal (21-Bl.l) I. Olecranon and radial head
from olecranon (21-Al.l) (1) olecranonone line (21-Cl.l)
(2) olecranontwo lines
(3) olecranonmulti fragmentary
(4) coronoid processalone ~
2. Metaphyseal simple (21-Al.2) 2. Coronoid process and radial

head (21-Cl.2)
2. Bifocal (21-Bl.2)
(21-Al.3)
3. Bifocal multifragmentary
(21-BI.3)
(1) multifragmentary olecranon
(2) multi fragmentary coronoid
process
(3) multifragmentary ofboth
~ -
At Bl Cl
RADIUS/ULNA ]9
Radius/Ulna, proximal, extra-ar- Radius/Ulna, proximal, articular, Radius/Ulna, proximal, articular,

ticular radius fractured (21-A2) radial fracture (21-B2) both bones, one simple the other
1. Avulsion of bicipital tuberosi- I. Simple (21-B2.1) multifragmentary (2l-C2)
ty of radius (21-A2.1) (1) non-displaced I. Olecranon multifragmentary,
(2) displaced radial head, simple (21-C2.1)
2. Neck simple (21-A2.2)

2. Multifragmentary without de-
2. Olecranon simple, radial head
pression (21-B2.2)
multifragmentary (21-C2.2)
-
3. Neck multifragmentary
(21-A2.3) 3. Multifragmentary with de-
pression (21-B2.3) 3. Coronoid process simple, ra-
dial head multifragmentary
(21-C2.3)
A2 B2 C2
c Orthop Trauma, f{)l. 10, Suppl. 1, 1996
~
20 RADIUS/ULNA
Radius/Ulna, proximal, extra-ar- Radius/Ulna,proximal, articular of Radius/Ulna, proximal, articular

ticular, fracture both bones (21- A3 ) one,extra-articularof other(21-B3) multifragmentary both bones
I. Simple of both bones (21-A3.1) I. Ulna articular simple (21-B3.1) (2l-C3)
(1) radius extra-articular simple I. Three fragments both bones
(2) radius extra-articular multi- (2l-C3.l)
fragmentary
2. Multifragmentary of one bone

and simple of other (21-A3.2)
2. Ulna, more than 3 fragments
(1) multifragmentary ulna
2. Radius articular simple (21-C3.2)
(2) multifragmentary radius
(21-B3.2) (1) radius, 3 fragments
(1) ulna extra-articular simple (2) radius, more than 3 fragments
(2) ulna extra-articular multifrag-
mentary
3. Multifragmentary of both
bones (21-A3.3) 3. Radius, more than 3 fragments
(21-C3.3)
2. Articular multifragmentary ( I) ulna, 3 fragments
(2I-B3.3) (2) ulna, epiphysio-diaphyseal
(I) ulna, radius extra-articular sim-
pie
(2) ulna, radius extra-articular mul-
tifragmentary
(3) radius, ulna extra-articular sim-
pIe
(4) radius, ulna extra-articular mul-
tifragmentary
A3 B3 C3
J Orthap Trouma, Val. JO, Suppl. 1, 1996

RAD IUS/ULNA 21

RADIUS/ULNA (2) Diaphyseal (22) A. Simple (22-A)
B. Wedge (22-8)
C. Complex (22-C)
J Orthop 1rauma, Vol. 10, Suppl. 1, 1996

22 RADIUS/ULNA
Groups: i
Radius/ulna, diaphyseal, simple Radius/ulna, diaphyseal, wedge Radius/ulna, diaphyseal, complex
(22-A) fracture (22-B) (22-C)
I. Ulna simple, radius intact I. Ulna fracture, radius intact I. Complex of ulna (22-Cl)
(22-AI) (22-Bl)
2. Complex of radius (22-C2)

2. Radius simple, ulna intact
2. Radius fracture, ulna intact
(22-A2)
(22-B2)
~
3. Complex of both bones(22-C3)

3. Simple fracture both bones
(22-A3) 3. Wedge fracture, simple or ~
wedge of other bone (22-B3)
~
A B c
JOrthopTrauma, Vol.10, Suppl.1, 1996
RADIUS/ULNA 23

Radius/ulna, diaphyseal, simple Radius/ulna, diaphyseal, wedge Radius/ulna, diaphyseal, complex
fracture ofulna (22-Al) fracture ofulna (22-BI) fracture of ulna (22-C I )
I. Oblique (22-Al.l) I. Intact wedge (22-BI.I) I. Bifocal, radius intact (22-CI.I)
(I) without dislocation
(2) with radial head dislocated
~
(Monteggia)
2. Transverse (22-Al.2) 2. Fragmented wedge (22-Bl.2)
2. Bifocal with radial fracture

(22-Cl.2)
(1) radius simple
(2) radius wedge
".
3. With dislocation of radial head 3. With dislocation of radial head

(Monteggia) (22-Al.3) (Monteggia) (22-Bl.3)
3. Irregular ofulua (22-Cl.3)

(1) radius intact
(2) radius simple
(3) radius wedge
At Bl Cl

24 RADIUS/ULNA
Radius/ulna, diaphyseal, simple Radius/ulna, diaphyseal, wedge Radius/ulna, diaphyseal,complex

fracture of radius (22-A2) fracture of radius (22-B2) fracture of radius (22-C2)
I. Oblique (22-A2.l) I. Intact wedge (22-B2.l) I. Bifocal, ulna intact (22-C2.1)
( 1) without dislocation
(2) with dislocation of distal radio-
ulnar joint (Galeazzi)
2. Transverse (22-A2.2) 2. Fragmented wedge (22-B2.2)
2. Bifocal, ulna fracture (22-C2.2)

( I) simple ulna
(2) wedge ulna
3. With dislocation of distal radio- 3.With dislocation of distal radio-

ulnar joint (Galeazzi) (22-A2.3) ulnar joint (Galeazzi) (22-B2.3)
3. Irregular (22-C2.3)
(1) ulna intact
(2) ulna simple
(3) ulna wedge
- --
A2 B2 C2
J Orthop Trauma, Vol. 10, Suppl1, 1996

RAD IUS/ULNA 25
Radius/ulna, diaphyseal, simple Radius/ulna,diaphyseal,wedge of Radius/ulna, diaphyseal, complex

fracture of both bones (22-A3) one, simple or wedge of other of both bones (22-C3)
(1) without dislocation (22-B3) I. Bifocal (22-C3.l)
(2) with dislocation of radial head (1) without dislocation
(Monteggia ) (2) with dislocation of radial head
(3) with dislocation of distal radio- (Monteggia)
ulnar joint (Galeazzi) (3) with dislocation of distal radio-
ulnar joint (Galeazzi)
(based on level of radial fracture) I. Ulna wedge,simple fracture ra-
1. Radius, proximal zone (22-A3 .1) dius (22-B3.1)
2. Bifocal of one, irregular of other

(22-C3.2)
( I) bifocal radius, irregular ulna
(2) bifocal ulna, irregular radius
2. Radius, middle zone (22-A3.2) 2. Radial wedge, simple fracture

of ulna (22-B3.2)
3. Radius, distal zone (22-A3.3)

3. Radial and ulnar wedge
(22-B3.3)
A3 B3 C3

26 RADIUS/ULNA

RADIUS/ULNA (2) Distal segment (23) A. Extra-articular (23-A)
B. Partial articular fracture of ra-

dius (23-B)
C. Complete articular fracture of

radius (23-C)
JOrthopTrauma, Val. 10, Suppl.l, 1996

RADIUS/ULNA 27
Groups:
Radius/ulna, distal, extra-articular Radius/ulna, distal, partial articu- Radius/ulna, distal, complete artic-
(23-A) lar radius (23-B) ular (23-C)
1. Extra-articular ulna fracture, I. Partial articular radius, sagit- I. Complete articular radius, sim-
radius intact (23-Al) tal (23-Bl) ple articular and metaphysis
(23-Cl)
2. Partial articular radius, dorsal

2. Extra-articular radius fracture, 2. Complete articular radius, sim-
rim (Barton) (23-B2)
ulna intact (23-A2) ple articular, metaphyseal multi-
fragmentary (23-C2)
3. Complete articular radius,

multifragmentary (23-C3)
3. Partial articular radius, volar
3. Extra-articular, multifrag-
rim (reverse Barton, Goyrand
mentary radius fracture (23-A3)
Smith II) (23-B3)
A B c
J Orthop 1)-auma, Vol. 10, Suppl. I, 1996
28 RADIUS/ULNA

Radius/ulna, distal, extra-articular Radius/ulna, distal, partial articu- Radius/ulna, distal, complete artic-
fracture ofulna (23-AI) lar fracture of radius, sagittal (23-B 1) ular fracture of radius, articular sim-
I. Ulna styloid process (23-Al.l) (I) radio-ulnar dislocation (fracture pIe, metaphyseal simple (23-C I )
of styloid process) ( I) radio-ulnar dislocation (fracture
(2) simple fracture of ulnar neck of styloid process)
(3) multi fragmentary fracture of (2) simple fracture of ulnar neck
ulnar neck (3) multifragmentary fracture of
(4) fracture of ulna head ulnar neck
(5) fracture of ulna head and neck (4) fracture of ulna head
(6) fracture proximal to ulnar neck (5) fracture of ulna head and neck
I. Lateral simple (23-Bl.l) (6) fracture proximal to ulnar neck
I. Postero-medial articular frag-
2. Metaphyseal simple (23-Al.2) ment (23-CI.I)
2. Lateral multifragmentary
(23-B 1.2)
(23-Al.3)
(1) wedge 2. Sagittal articular fracture line
(2) complex
(23-Cl.2)
3. Medial (23-81.3)
3. Frontal articular fracture line

(23-Cl.3)
~,.."\
Q\-J
At Bl Cl
RADIUS/ULNA 29
Radius/ulna.distal. extra-articular Radius/ulna, distal, partial articu- Radius/ulna,distal, completeartic-

fracture of radius. simple meta- lar fracture of radius, dorsal rim (Bar- ular fractureof radius,articularsim-
physealand impacted (23-A2) ton's) (23-B2) ple, metaphysealmulti fragmentary
( 1) radio-ulnardislocation(fracture (I) radio-ulnar dislocation (fracture (23-C2)
of styloid process) of Styl9id process) (I) radio-ulnardislocation(fracture
(2) simple fracture of ulnar neck (2) simple fracture of ulnar neck of styloid process)
(3) multifragmentary fracture of (3) multifragmentary fracture of (2) simple fracture of ulnar neck
ulnar neck ulnar neck (3) multifragmentary fracture of
(4) fracture of ulna head (4) fracture of ulna head ulnar neck
(5) fracture of ulna head'.andneck (5) fracture of ulna head and neck (4) fracture of ulna head
(6) fracture proximal to ulnar neck (6) fracture proximal to ulnar neck (5) fracture of ulna head and neck
I. Transverse, no tilt, but may be I. Simple (23-B2.1) (6) fracture proximal to ulnar neck
axially shortened (23-A2.1) I. Sagittal articular fracture line
(23-C2.1)
2. With lateral sagittal fracture

2. With dorsal tilt, oblique frac- (23-B2.2) 2. Frontal articular fracture line
tore upward and back (Pouteau- (23-C2.2)
Colles) (23-A2.2)
3. With dorsal dislocation of car-

3. Extending into diaphysis (23-
pus (23-B2.3)
3. Volar tilt, oblique upwards and C2.2)
forward (Goyrand-Smith)(23-A2.2)
A2 B2 C2

30 RADIUS/ULNA
Radius/ulna, distal, extra-articular Radius/ulna, distal, partial articu- Radius/ulna,distal, completeartic-

fracture of radius, multifragmen- lar fracture ofradius, volar rim (re- ular fracture of radius, multifrag-
tary (23-A3) verse Barton's, Goyrand-Smith II) mentary(23-C3)
(I) radio-ulnar dislocation (fracture (23-B3) (1) radio-ulnar dislocation(fracture
of styloid process) (1) radio-ulnar dislocation (fracture of styloid process)
(2) simple fracture of ulnar neck of styloid process) (2) simple fracture of ulnar neck
(3) multi fragmentary fracture of (2) simple fracture of ulnar neck (3) multi fragmentary fracture of
ulnar neck (3) multi fragmentary fracture of ulnar neck
(4) fracture of ulna head ulnar neck (4) fracture ofulna head
( 5) fracture of ulna head and neck (4) fracture ofulna head (5) fracture ofulna head and neck
( 6) fracture proximal to ulnar neck (5) fracture ofulna head and neck (6) fracture proximal to ulnar neck
I. Impacted with axial shorten- ( 6) fracture proximal to ulnar neck I. Metaphyseal simple (23-C3.1)
ing (23-A3.1) I. Simple with small fragment
(23-B3.1)
(j8(J
(23-C3.2)
2. With a wedge (23-A3.2) 2. Simple with larger fragment
(23-B3.2)
3. Extending into diaphysis

3. Multifragmentary (23-B3.3) (23-C3.3)
i-.J
'00
A3 B3 C3
Orthop Trauma, Vol. 10, Suppl. 1, 1996
FEMUR 31
FEMUR

FEMUR (3) Proximal segment (31) A. Trochanteric area (31-A)
n
B. Neck fractures (31-B)
c. Head fractures (31-C)

32 FEMUR
Groups:
Femur, proximal trochanteric (3l-A) Femur, proximal. neck fracture Femur, proximal, head fracture
I. Pertrochanteric simple (31-Al) (31-B) (31-C)
I. Subcapital with slight dis- I. Split (31-Cl)
placement (31- B 1)
;,
:if{~
2. Pertrochanteric multifrag-
2. With depression (31-C2)
mentary (31-A2) 2. Transcervical (31-B2)
3. Intertrochanteric (31-A3) 3. With neck fracture (31-C3)

3. Subcapital with marked dis-
placement (31-B3)
A B c
FEMUR 33

Femur, proximal, pertrochanteric Femur, proximal, neck fracture, Femur, proximal, head fracture,
simple (31-AI) (only 2 fragments) slight displacement(31-B1) split (31-C 1)
I. Along intertrochanteric line 1. Impacted in valgus ? 15° I. Avulsion of ligamentum teres
(31-AI.I) (31-BI.1) (Garden 1/1) (31-Cl.l )
(I) posterior tilt < 15°
(2) posterior tilt > 15°
2. Through the greater trochanter 2. With rupture of ligamentum

(31-Al.2) 2. Impacted in valgus < 15° teres (31-Cl.2)
(1) non-impacted
(31-Bl.2) (Garden 1/2)
(2) impacted (1) posterior tilt < 15°
(2) posterior tilt > 15°
3. Large fragment (31-Cl.3)
3. Below lesser trochanter (31-AI.3)

(1) high variety, medial fracture line
at lower limit of lesser trochanter 3. Non-impacted (31-Bl.3) (Gar-
(2) low variety, medial fracture line den II)
in diaphysis below lesser trochanter
At Bl Cl

34 FEMUR
Femur, proximal, trochanteric frac- Femur, proximal, neck fracture, tran- Femur, proximal, head fracture, with
ture, pertrochanteric multifragmen- scervica1 (31- B2) depression (3l-C2)
tary (always have posteromedial I. Basicervical (31-B2.1) I. Posterior and superior (3l-C2.l)
fragment with lesser trochanter and
adjacent medial cortex) (3l-A2)
I. With one intermediate frag-
ment (3l-A2.l)
2. Mid cervical adduction (31-B2.2) 2. Anterior and superior (31-C2.2)
2. With several intermediate frag-

ments (31-A2.2)
3. Mid cervical shear (31-82.3)

3. Split depression (31-C2.3)
3. Extending more than 1 cm

below lesser trochanter (31-A2.3)
A2 B2 C2

FEMUR 35
Femur, proximal, trochanteric area, Femur, pro~a1, neck fracture, sub- Femur, proximal, head fracture with
intertrochanteric fracture (31-A3) capital, non-impacted displaced neck fracture (3l-C3)
1. Simple oblique (31-A3.1) (3l-B3) I. Split and transcervical neck
I. Moderate displacement in fracture (3l-C3.1)
varus and external rotation
(31-B3.1) (Garden III)
2. Simple transverse (31-A3.2) 2. Split and sobcapital neck frac-

2. Moderate displacement with tore (31-C3 .2)
vertical translation and external
rotation (31-B3.2) (Garden IV)
3. Depression and neck fracture
( 1) extending to greater trochanter
3. Marked displacement (31-B3.3) (31-C3.3)
(2) extending to neck
(Garden III/IV)
(1) in varus
(2) with translation
Ii
A3 B3 C3

36 FEMUR

FEMUR (3) Diaphyseal segment (32) A. Simple (32-A)
B. Wedge (32-B)
C. Complex (32-C)

FEMUR 37
Groups:
Femur, diaphyseal, simple fracture Femur, diaphyseal, wedge fracture Femur,diaphyseal,complex (32-C)
(32-A) (32-B) I. Spiral (32-CI)
I. Spiral (32-Al) I. Spiral wedge (32-BI)
2. Oblique (~ 300) (32-A2) 2. Bending wedge (32-B2)

2. Segmental (32-C2)
3. Transverse « 300) (32-A3)

A B c
J Orthov Trauma. Vol. 10. Suvvl. 1. 1996
38 FEMUR

Femur, diaphyseal, simple spiral Femur, diaphyseaJ,wedge spiral Femur,diaphyseal,complex spiral
(32-Al) (32-Bl) (32-CI)
I. Subtrochanteric zone (32-Al.l) I. Subtrochanteric zone (32-Bl.l) (1) pure diaphyseal
(2) proximal diaphysio-metaphy-
seal
1.With 2 intermediate fragments
(32-CI.I)
2. Middle zone (32-Al.2)
2. Middle zone (32-B 1.2)
2. With 3 intermediate fragments

(32-Cl.2)
3. Distal zone (32-Al.3)
3. Distal zone (32-BI.3)

3. With more than 3 intermediate
fragments (32-Cl.3)
At Bl Cl

FEMUR 39
Femur, diaphyseal, simple oblique Femur, diaphyseal, wedge, bending Femur, diaphyseal, complex seg-
(? 300) (32-A2) (32-B2) mental (32-C2)
I. Subtrochanteric zone (32-A2.l) 1. Subtrochanteric zone (32-B2.l) 1. With one intermediate seg-
mental fracture (32-C2.1)
(I) pure diaphyseal
seal
(4) oblique lines
2. With one intermediate seg-

mental and additional wedge
fragments (32-C2.2)
t/
( I) pure diaphyseal
seal
(4) distal wedge
(5) two wedges,proximal and distal

(1) pure diaphyseal
seal
t.!.,
A2 B2 C2
~
40 FEMUR
Femur, diaphyseal,transverse(< 300) Femur, diaphyseal, wedge fragment- Femur,diaphyseal,complexirregu-

(32-A3) ed (32-B3) lar (32-C3)
I. Subtrochanteric zone (32-A3.1) 1. Subtrochanteric zone (32-B3.1) I. With 2 or 3 intermediate frag-
ments (32-C3.1)
(I) two main intermediate frag-
ments
(2) three main intermediate frag-
ments

2. With limited shattering « Scm)

(32-C3.2)
( 1) proximal zone
(2) middle zone
(3) distal zone
3. With extensive shattering

(~ Scm) (32-C3.3)
( I) pure diaphyseal
L{Ij
A3 B3 C3
Orthap Trauma, Val. 10, Suppl. I, 1996
FEMUR 4]

FEMUR (3) Distal segment (33) A. Extra-articular (33-A)
B. Partial articular (33-B)
C. Complete articular (33-C)
JOrthopTrauma, Vol.IO, Suppl.l,1996

42 FEMUR
Groups:
Femur, distal, extra-articular (33-A) Femur, distal, partial articular (33-B) Femur, distal, complete articular
I. Simple (33-Al) I. Lateral condyle, sagittal (33-Bl) (33-C)
I. Articular simple, metaphyseal
simple (33-Cl)
~,
,1. ~
~,
G~;;
--
,- I
). I
\~ I
, I' ,
2. Metaphyseal wedge (33-A2) 2. Medial condyle, sagittal (33-B2)

2. Articular simple, metaphyseal
3. Frontal (33-B3)
3. Metaphyseal complex (33-A3)
3. Multifragmentary articular
fracture (33-C3)
A B c
FEMUR 43

Femur, distal, extra-articular sim- Femur, distal, partial articular, lat- Femur, distal, complete articular,
ple (33-AI) eral condyle, sagittal (33-Bl) articular simple, metaphyseal sim-
1.Apophyseal (33-AI.l) I. Simple through the notch ple (33-CI)
(1) avulsion lateral epicondyle (33-Bl.l) I. T or y shaped with slight dis-
(2) avulsion medial epicondyle placement (33-CI.I)
2. Simple through load bearing

2. Metaphyseal oblique or spiral 2. T or y shaped with marked dis-
surface (33-Bl.2)
(33-Al.2) placement (33-Cl.2)
3. Multifragmentary (33-Bl.3) 3. T shaped epiphyseal (33-C .3)

3. Metaphyseal transverse
(33-Al.3)
At Bl Cl
JOrthopTrauma,Vol.10, Suppl.1, 1996

44 FEMUR
Femur, distal, extra-articular, meta- Femur,distal, partial articular, me- Femur, distal, complete articular,
physeal wedge (33-A2) dial condyle, sagittal (33-B2) articular simple, metaphysealmul-
I. Intact wedge (33-A2.1) I. Simple through notch (33-B2.1) tifragmentary (33-C2)
(I) lateral 1. With intact wedge (33-C2.1)
(2) medial (1) lateral
(2) medial
2. Simple through load bearing

surface (33-B2.2)
2. Fragmented lateral (33-A2.2) 2. With fragmented wedge

(33-C2.2)
(1) lateral
(2) medial
3. Multifragmentary (33-82.3)
3. Fragmented medial (33-A2.3)
A2 B2 C2
FEMUR 45
Femur, distal, extra-articular, meta- Femur, distal, partial articular, Femur, distal, complete articular,
physeal complex (33-A3) frontal (33-B3) articular multi fragmentary (33-C3)
I. With an intermediate split seg- 1.Anterior and lateral flake frac- I. Metaphyseal simple (33-C3.1)
ment (33-A3.1) ture (33-B3.1)
I' ; ~ ""
, f" ,
~ '" I I
r- -,
A. J
I A
.'\ ,
2. Unicondylar posterior (Hoffa) 2. Metaphyseal multifragmentary
(33-B3.2) (33-C3.2)
2. Irregular limited to metaphysis ( 1) lateral
(33-A3.2) (2) medial
r-.:;.~~--"
.A. I
C 8\. ,
, ., ,
3. Metaphysio-diaphyseal multi-
3. Bicondylar posterior (33-B3.3)
fragmentary (33-C3.3)
3. Irregular extending to diaph-

ysis (33-A3.3)
--- ""
.. I
\~ I
,"
A3 B3 C3

46 TIBIA/FIBULA
TIBIA/FIBULA
BONE: Location: Jypes:

TIBIA/FIBULA (4) Proximal segment (41) A. Extra-articular (41-A)
B. Partial articular (41-B)
C. Complete articular (41-C)
Orthap Trauma, Val. 10, SuppL 1, 1996

TIBIA/FIBULA 47
Groups:
Tibia/Fibula, proximal, extra-artic- Tibia/fibula, proximal, partial ar- Tibia/fibula, proximal, complete
ular (4l-A) ticular (4l-B) articular (4l-C)
1. Avulsion (41-Al) I. Pure split (4l-Bl) 1. Articular simple, metaphyseal
simple (4l-Cl)
2. Pure depl'ession (41-82)
2. Metaphyseal simple (41-A2) 2. Articular simple, metaphyseal

multifragmentary ( 41-C2)
3. Split depression (41-83)
3. Metaphyseal multifragmentary 3. Articular multifragmentary
(41-A3) (41-C3)
A B c
J Orthap Trauma, Val. 10, Suppl. 1,1996
48 TIBIA/FIBULA

ular, avulsion (4l-AI) ticular, split ( 41- B I ) articular, simple articular, simple
I. Of fibular head (4l-Al.l) I. Of lateral surface (41-BI.I) metaphysis ( 4l-C 1)
(1) marginal ( 1) intact anterior tibial tubercle and
(2) sagittal intercondylar eminence
(3) frontal anterior (2) anterior tibial tubercle involved
(4) frontal posterior (3) intercondylar eminence involved
I. Slight displacement ( 4l-C 1.1)
2. Of tibial tuberosity (41-Al.2)
(C!)
2. Of medial surface (41-BI.2)
(I) marginal
(2) sagittal 2. One condyle displaced (41-Cl.2)
(3) frontal anterior
(4) frontal posterior
3. Ofcruciate insertion (41-Al.3)

(1) anterior
(2) posterior
3. Both condyles displaced

3. Oblique, involving the tibial (41-Cl.3)
spines and one of the surfaces
(41-Bl.3) ~
(1) lateral
(2) medial
!QD
Al Bl Cl
TIBlAIFIBULA 49
ular, simple metaphysis(4l-A2) ticular, depression(41-B2) articular, articular simple, metaph-
I. Oblique in frontal plane I. Lateral total (41-B2.1) ysis multi fragmentary (41-C2)
(41-A2.1) (I) one piece I. Intact wedge (41-C2.1)
(2) mosaic-like (1) lateral
(2) medial
rr """'
\
1,
I
2. Oblique in sagittal plane
(41-A2.2) 2. Fragmented wedge (41-C2.2)

2. Lateral limited (41-B2.2) ( 1) lateral
(1) peripheral (2) medial
(2) central
(3) anterior
(4) posterior
3. Transverse (41-A2.3)
3. Medial (41-B2.3)
( 1) central
(2) anterior
(3) posterior
(4) total
A2 B2 C2
J Orthop Trauma, IVI. 10, Suppl. 1, 1996

50 TIBIA/FIBULA
ular, multifragmentary metaphysis ticular, split depression(41-83) articular, articular multifragmen-
(4l-A3) 1. Lateral (41-83.1) tary (41-C3)
I. Intact wedge (4l-A3.l) (I) antero-lateraldepression (1) metaphysealsimple
( 1) lateral (2) postero-lateraldepression (2) metaphyseallateral wedge
(2) medial (3) antero-medialdepression (3) metaphysealmedial wedge
(4) postero-medialdepression (4) metaphysealcomplex
(5) metaphysio-diaphyseal complex
1. Lateral (41-C3.1)
2. Fragmented wedge (41-A3.2)

(I) lateral
(2) medial
2. Medial (41-B3.2)
( I) antero-lateral depression
(2) postero-lateral depression
(3) antero-medial depression
( 4) postero-medial depression 2. Medial (41-C3.2)
(1) slightly displaced
(2) significantly displaced
3. Oblique involving the tibial

spines and one of the surfaces
(41-83.3) 3. Lateral and Medial (41-C3.3)
(1) lateral
(2) medial
A3 B3 C3
J Orthav Trauma. Val. 10. Suvvl. 1. 1996

TIBIA/FIBULA 51

TIBIA/FIBULA (4) Diaphyseal segment (42) A. Simple (42-A)
B. Wedge ( 42-B)
C. Complex (42-C)
J Orthap Irauma, Val. 10, Suppl. 1, 1996

52 TIBIA/FIBULA
Groups:
Tibia/fibula, diaphyseal, simple Tibia/fibula, diaphyseal, wedge Tibia/fibula, diaphyseal,complex
( 42-A) (42-B) (42-C)
I. Spiral (42-Al) I. Spiral wedge (42-BI) I. Spiral (42-Cl)
2. Oblique (? 300) ( 42-A2) 2. Bending wedge (42-B2)
2. Segmented (42-C:
3. Transverse « 300) (42-A3)

A B c
Orthap Trauma, Val. 10, Suppl. 1, 1996
TIBIA/FIBULA 53

Tibia/fibula, diaphyseal, simple, Tibia/fibula, diaphyseal, wedge, Tibia/Fibula, diaphyseal, complex,
spiral (42-Al) spiral (42-BI) spiral (42~CI)
(1) proximal zone (I) proximal zone (I) pure diaphyseal
(2) middle zone (2) middle zone (2) proximal diaphysio~metaphysis
(3) distal zone (3) distal zone (3) distal diaphysio~metaphysis
I. Fibula intact (42-Al.l) I. Fibula intact (42-Bl.l) I. With two intermediate frag~
ments (42~CI.I)
2. Fibula fracture at different 2. Fibula fracture at different

level (42-Al.2) level (42-Bl.2) 2. With three intermediate frag-
ments (42-Cl.2)
3. Fibula fracture at same level 3. Fibula fracture at same level

(42-Al.3) (42-81.3) 3. With more than three interme-
diate fragments (42-Cl.3)
At Bl Cl
J Orthap Trauma, Val. 10, SuppL 1, 1996

54 TIBIA/FIBULA
Tibia/fibula, diaphyseal, simple, Tibia/fibula, diaphyseal, wedge, Tibia/Fibula, diaphyseal,complex

oblique (:::::0
300) (42-A2) bending (42-B2) segmental(42-C2)
( 1) proximal zone (I) proximal zone I. With an intermediate segmen-
(2) middle zone (2) middle zone tal fragment (42-C2.1)
(3) distal zone (3) distal zone (I) pure diaphyseal
I. Fibula intact ( 42-A2.l ) 1. Fibula intact (42-B2.1) (2) proximal diaphysio-metaphyseal
(4) oblique lines
2. Fibula fracture at different 2. Fibula fracture at different 2. With an intermediate segmen-

level (42-A2.2) level (42-B2.2) tal and additional wedge frag-
ment(s) (42-C2.2)
(4) distal wedge
(5) 3 wedges,proximal and distal
3. Fibula fracture at same level 3. Fibula fracture at same level

(42-A2.3) (42-B2.3)

A2 B2 C2
~
TIBIA/FIBULA 55
Tibia/fibula, diaphyseal, simple, Tibia/fibula, diaphyseal, wedge Tibia/fibula, diaphyseal, complex,

transverse « 300) (42-A3) fragmented (42-B3) irregular (42-C3)
(I) proximal zone (I) proximal zone I. With two or three intermediate
(2) middle zone (2) middle zone fragments (42-C3.1)
(3) distal zone (3) distal zone (1) 2 intermediate fragments
I. Fibula intact (42-A3.1) 1. Fibula intact (42-B3.1) (2) 3 intermediate fragments
2. Fibula fracture at different 2. Fibula fracture at different 2. Limited shattering « 4cm)

level (42-A3.2) level (42~B3.2) (42-C3.2)
3. Fibula fracture at same level 3. Fibula fracture at same level 3. Extensive shattering (> 4cm)
(42-A3.3) (42-B3.3) (42-C3.3)
(2) prox.imal diaphysio-metaphyseal
A3 B3 C3
J Orthop Trauma, Vol. 10, Suppl. 1996

56 TIBIA/FIBULA

TIBIA/FIBULA (4) Distal segment (43) A. Extra-articular (43-A)
B. Partial articular ( 43-B)
C. Complete articular ( 43-C)

TIBIA/FIBULA 57
Groups:
Tibia/Fibula, distal, extra-articular Tibia/fibula, distal, partial articu- Tibia/fibula, distal, complete ar-
(43-A) lar (43-8) ticular (43-C)
I. Metaphyseal simple (43-Al) I. Pure split (43-81) I. Articular simple, metaphysis
simple (43-CI)
2. Metaphyseal wedge ( 43-A2) 2. Split depression (43-82)

2. Articular simple, metaphysis
3. Multifragmentary depression
3. Metaphyseal complex (43-A3) (43-B3)
;\1;1 3. Articular multifragmentary
:~~!~ (43-C3)
/,
\..-
A B c
58 TIBIA/FIBULA

Tibia/Fibula, distal, extra-articular, Tibia/fibula, distal, partial articu- Tibia/fibula, distal, complete ar-
simple (43-Al) lar, pure split (43-8 1) ticular, articular simple, metaphy-
(1) fibula intact (1) fibula intact seal simple (43-Cl)
(2) simple fracture of fibula (2) simple fracture of fibula ( 1) fibula intact
(3) multi fragmentary fracture of (3) multi fragmentary fracture of (2) simple fracture of fibula
fibula fibula (3) multifragmentary fracture of
(4) bifocal fracture of fibula (4) bifocal fracture of fibula fibula
I. Spiral (43-Al.l) I. Frontal (43-81.1) (4) bifocal fracture of fibula
(5) anterior I. Without impaction (43-Cl.l)
(6) posterior (Volkmann) (5) frontal plane
(6) sagittal plane
I
I
I
\/
\
2. Oblique (43-Al.2)
2. Sagittal (43-Bl.2) 2. With epiphyseal depression

(5) lateral (43-Cl.2)
(6) medial (medial malleolus)
3. Transverse (43-Al.3)

(43-Cl.3)
(43-81.3)
At Bl Cl
TIBIA/FIBULA 59
wedge ( 43-A2) lar, split depression(43-B2) ticular, articular simple, multifrag-
(I) fibula intact (1) fibula intact mentary metaphysis(43-C2)
(2) simple fracture of fibula (2) simple fracture of fibula (I) fibula intact
(3) multi fragmentary fracture of (3) multifragmentary fracture of (2) simple fracture of fibula
fibula fibula (3) multi fragmentary fracture of
I. Postero-lateral impaction I. Frontal (43-B2.l) (4) bifocal fracture of fibula
(43-A2.1) (5) anterior I. With asymmetric impaction
(6) posterior (43-C2.1)
(5) frontal plane split
(6) sagittal plane split
2. Antero-medial wedge (43-A2.2)

2. Sagittal (43-B2.2)
(5) lateral
(6) medial
2. Without asymmetric impaction
(43-C2.2)
'-"

( 43-A2.3)
3. Of the central fragment
(43-B2.3)
(43-C2.3)
A2 B2 C2
J Orthop Trouma, Vo1. 10, Suppl. I, 1996

60 TIBIA/FIBULA
complex (43-A3) lar, depression(43-B3) ticular, articular multifragmentary
(I) fibula intact (1) fibula intact (43-C3)
(2) simple fracture of fibula (2) simple fracture of fibula (I) fibula intact
(3) multi fragmentary fracture of (3) multifragmentary fracture of (2) simple fracture of fibula
fibula fibula (3) multi fragmentary fracture of
I. Three intermediate fragments I. Frontal (43-B3.1) (4) bifocal fracture of fibula
(43-A3.1) (5) anterior I. Epiphyseal (43-C3.I)
(6) posterior
--
~
L
...,
2. Epiphysio-metaphyseal (43-C3.2)
2. Sagittal (43-B3.2)
2. More than three intermediate
(5) lateral
fragments (43-A3.2)
(6) medial
..."
3. Epiphysio-metaphysio-diaphy-
seal (43-C3.3)
3. Metaphyseal, multifragmen-
3. Extending into diaphysis tary (43-83.3)
(43-A3.3)
v/
(
-,
'--
A3 B3 C3
J Orthop Trauma, VoL 10, SuppL 1, 1996
TIBIA/FIBULA 61

TIBIA/FIBULA (4) Malleolar segment (44) A. Infrasyndesmotic lesion (44-A)
B. Transsyndesmotic fibula frac-

ture (44-B)
C. Suprasyndesmotic lesion (43-C)

62 TIBIA/FIBULA
Groups:
Tibia/Fibula, malleolar, infrasyn- Tibia!Fibula, malleolar, transsyn- Tibia/Fibula, malleolar, suprasyn-
desmotic lesions ( 44-A) desmotic fibula fracture (44-B) desmotic ( 44-C)
I. Isolated (44-Al) I. Isolated (44-Bl) I. Simple diaphyseal fibular frac-
ture ( 44-C 1)
\~-.Y
~ -..,
, f
-..I
2. With medial malleolar fracture 2. With medial lesion (44-B2)

(44-A2)
2. Multifragmentary fracture of
fibular diaphysis (44-C2)
~-'
3. With medial lesion and Volk-

3. With postero-medial fracture mann (fracture of the postero-lat-
(44-A3) eral rim) (44-B3)
3. Proximal fibula (44-C3)
A B c
JOrthap Trauma, Val. 10, SuppL 1,1996
TIBIA/FIBULA 63

Tibia/fibula, malleolar, infrasyn- Tibia/fibula, malleolar, transsyn- Tibia/Fibula, malleolar, susprasyn-
desmotic, isolated (44-Al) desmotic, isolated (44-Bl) desmotic, simple diaphyseal frac-
I. Rupture of lateral coUaterallig- I. Simple (44-BI.l) ture of fibula ( 44-C 1)
ament (44-Al.l) I. Rupture of medial collateral
ligament ( 44-C 1.1)
~=7
1,..1
,..,I
2. Simple with rupture of anteri- J--

2. Avulsion of tip of lateral malle- or syndesmosis (44-BI.2)
olus (44-Al.2) (I) in substance
(2) Chaput (anterior tibia) 2. With fracture of medial malle-
(3) Lefort (anterior fibula)
olus (44-Cl.2)
-.J
3. Transverse fracture of lateral

,-
malleolus (44-Al.3)
3. Multifragmentary (44-81.3)
3. With fracture of medial malle-

olus and a Volkmann (Dupuytren)
(44-Cl.3)
( 1) extra-articular avulsion
(2) peripheral articular fragment
(3) significant articular fragment
~...
At Bl Cl

64 TIBlAIFIBULA
Tibia/fibula, malleolar, infrasyn- Tibia/Fibula, malleolar, transsyn- Tibia/Fibula, malleolar, suprasyn-

desmoticlesion with medial malle- desmotic fracture with medial desmotic, multifragmentary fibu-
olar fracture (44-A2) malleolar lesion (44-B2) lar diaphysealfracture (44-C2)
( 1) transverse I. Simple, rupture of medial col- I. With rupture of medial collat-
(2) oblique lateral and anterior syndesmosis eralligament (44-C2.l )
(3) vertical (44-B2.l)
I. Rupture of lateral coUaterallig- (I) in substance
ament(44~A2.1) (2) Chaput
(3) Lefort
=1 '--
,
,,"-1
2. With fracture of medial malle-

olus ( 44-C2.2)
2.Avulsion of tip of lateral malle-
olus (44-A2.2) 2. Simple with fracture of medi-
al malleolus and rupture of ante-
rior syndesmosis(44-B2.2)
(1) in substance
(2) Chaput
(3) Lefort
3. Transverse fracture of lateral 3. With fracture of medial malle-

~==}
malleolus (44-A2.3) I , olus and a Volkmann (Dupuytren)
"
(44-C2.3)
( I) extra-articular avulsion
(2) peripheral articular fragment
3. Multifragmentary (44-B2.3) (3) significant articular fragment
(1) rupture ofmedial collaterallig-
ament
(2) fracture ofmedialmalleolus
,,"-,
~==)
A2 B2 C2
~
TIBlAIFIBULA 65
Tibia/fibula, malleolar, infrasyn- Tibia/fibula, malleolar, transsyn- Tibia/fibula, malleolar, suprasyn-

desmotic lesion with postero-me- desmotic with medial lesion and a desmotic, proximal fibular lesion
dial fracture (44-A3) Volkmann (fracture ofpostero-Iat- (44-C3)
I. Rupture of lateral coUaterallig- eral rim) (44-B3) (1) fracture through neck
ament (44-A3.l) ( I) extra-articular avulsion (2) fracture through head
(2) peripheral articular fragment (3) proximaltibio-fibular dislocation
(3) significant articular fracture (4) ruptureof medial collateralliga-
1. Fibula simple with medial col- ment
lateral ligament rupture (44-B3.1) (5) fracture of medial malleolus
(6) articular fragment
1. Without shortening, without
Volkmann (44-C3.1)
2. Avulsion of tip of lateral malle-

olus (44-A3.2) 2. Simple fibula fracture with
fracture of medial malleolus
(44-B3.2)
2. With shortening, without Volk-

mann (44-C3.2)
\f
3. Transverse fracture of lateral

malleolus (44-A3.3)
3. Multifragmentary with frac-
ture of medial malleolus (44-83.3)
3. Medial lesion and a Volkmann
(44-C3.3)
\'\\
--
A3 B3 C3
, Orthap Trauma, Val. 10, Suppl.
1996
66 PELVIS
PELVIS
BONE: Location:
PELVIS (6) Pelvic Ring (61)
The classification of pelvic ring logical stresseswithout displace-

and acetabular fractures is based ment.
solely on the work of Pennal and Partially stable: posterior oste-
Tile and Judet and Letournel. This oligamentous integrity partially
classification was developed to ac- maintainedand pelvic floor intact.
commodate the alpha-numeric sys- Unstable:completeloss of pos-
tem of The Comprehensive Long terior osteoligamentousintegrity;
Bone System. pelvic floor disrupted.
Types:
A. Lesion sparing (or with no dis-
DEFINITIONS Where appropriate, the Young-
placement ot) posterior arch
Burgess classification has been
Pelvic ring has two arches: (a) added to the Subgroup and Quali- (61-A)
posterior arch is behind acetabular fication Section. Although these
surface and includes sacrum, tenns are not part of the alpha-nu-
sacroiliac joints and their ligaments meric code, they are added so that
and posterior ilium, and (b) ante- those using this classification can
rior arch is in front of acetabular easily code into the alpha-numeric
surface and includes pubic rami system for documentation. The fol-
bone and symphyseal joint. lowing are the definitions of the
Anterior column of acetabulum Young-Burgess System:
extends from the anterior half of A.P.C.: anterior-posterior com-
the iliac crest to the pubis (iliopu- pression; L.C.: lateral compression;
B. Incomplete disruption of pos-
bic). V:S.: vertical shear; C.M.I.: com-
terior arch; partially stable
Posterior column of acetabulum bined mechanical instability.
extends from the greater sciatic (61-B)
notch to the ischium (ilioischial).
ACKNOWLEDGEMENTS
Unilateral: only one hemipelvis
involved posteriorly. The 0. T.A. Coding and Classi-
Bilateral: both hemipelvis in- fication Committee gratefully ac-
volved posteriorly. knowledges the following individ-
Contralateral: the side opposite uals for their significant
the major posterior lesion. contributions to the development
Ipsilateral: the side of the more of systematic universal pelvic and
severe lesion. acetabular classifications:
Stable: lesion sparing the pos- Emile Letournel, M.D.; Marvin
C. Complete disruption of poste-
terior arch; pelvic floor intact and Tile, M.D.; Balz Isler, M.D.; David
rior arch; unstable (61-C)
able to withstand normal physio- Helfet, M.D.; Serge Nazarian, M.D.
J Orthap Trauma, Val. 10, Suppl. 1996

PELVIS 67
Groups:
Pelvis, ring, stable (61-A) Pelvis, ring, partially stable(61-8) Pelvis,ring, completedisruption of
I. Fracture of innominate bone; I. Unilateral, partial disruption posterior arch unstable(61-C)
avulsion (61-Al) of posterior arch, external rota- I. Unilateral, complete disruption
tion ("open-book" injury) (61-81) of posterior arch (61-CI)
2. Fracture of innominate bone;

direct blow (61-A2)
2. Unilateral, partial disruption

2. Bilateral, ipsilateral complete,
of posterior arch, internal rota-
contralateral incomplete (61-C2)
tion (lateral compression injury)
(61-82)
3. Transverse fracture of sacrum

and coccyx (61-A3)
3. Bilateral, complete disruption

3. Bilateral, partial lesion of pos- (61-C3)
terior arch (61-B3)
A B c
J Orthop Irauma, Vol. 10, Suppl. 1, 1996
68 PELVIS

Pelvis, ring, stable, avulsion of in- Pelvis,ring, partially stable,unilat- Pelvis, ring, complete disruption,
nominate bone (61-AI) eral, external rotation (open book, unilateral (A.P.C.-III) (61-Cl)
I. Iliac spine (61-Al.l) A.P.C.-II) (61-Bl) I. Through ilium (61-Cl.l, c***)
( 1) anterior superior (1) ipsilateral
(2) anterior inferior (2) contralateral
(3) pubic spine (3) anterior lesion
I. Sacroiliac joint anterior dis-
ruption (61-Bl.l)
~ '1>
2. Through sacroiliac joint

(6l-Cl.2, c***)
2. Iliac crest (61-Al.2) (at) transiliac fracture dislocation
(a2) pure dislocation
( a3)trans sacral fracture dislocation
"",
~
~
2. Sacral fracture (61-Bl.2, c***)

':I
'-J v-
l'
~
"
.,
3. Ischial tuberosity (61-Al.3)
3. Through the sacrum (61-CI.3,

c***)
(a') lateral (ala)
( a2) foraminal
(a3) medial to foramen
~
., ;f
'-' '-'
'r
c;jr
At Bl Cl

PELVIS 69
Pelvis, ring, stable, innominate Pelvis,ring, partially stable,unilat- Pelvis, ring, unstable,bilateral, ip-
bone, direct blow (61-A2) eral, internal rotation (l~teral com- silateral complete,contralateralin-
1.l1iac wing (61-A2.1) pression) (61-B2) complete (L.P.C.-III) (6l-C2)
(I) one fragment 1.Anterior compression fracture I. Complete through ilium
(2) more than one fragment of sacrum (L.P.C.-I) (6l-B2.1) (61-B2.1, b*, c***)
( 1) anterior lesion ipsilateral
(2) anterior lesion contralateral
(bucket handle)
2. Complete through sacroiliac

2. Unilateral fracture of anterior joint (6l-B2.2, b*, c***)
arch (61-A2.2) (a') transiliac fracture dislocation
(1) through pubic bone/rami ( a2)pure dislocation
(2) through pubic bone involving (a3) transsacral fracture dislocation
symphysis pubis 2. Partial sacroiliac joint fracture/
subluxation (L.P.C.-II) (6l-B2.2)
( 1) anterior lesion ipsilateral
(bucket handle)
",,",,'
")
& 3. Complete through the sacrum

(61-B2.3, b*, c***)
(a1) lateral (ala)
( a2) foraminal
(a3) medial to foramen
3. Bifocal fracture of anterior
arch (61-A2.3)
(I) bilateral pubic rami
3. Incomplete posterior iliac frac-
(2) pubic rami on one side and sym-
ture (L.P.C.-II) (61-B2.3)
physis pubis ( I) anterior lesion ipsilateral
(bucket handle)
*b: Contralateral pelvic lesion:

(b') external rotation, "open book" partial
disruption: .1) sacroiliac joint anterior dis-
ruption; .2) sacral fracture
(b') internal rotation, "lateral compression"
partial disruption: .1) anterior compression
fracture of the sacrum; .2) partial sacroili-
ac joint fracture/subluxation; .3) incomplete
posterior iliac fracture
A2 B2 C2
J Orthap Trauma, Val, 10, Suppl. 1, 1996

70 PELVIS
Pelvis, ring, stable, transverse frac- Pelvis, ring, partially stable,bilat- Pelvis, ring, unstable, bilateral
ture of sacrum and coccyx (61-A3) eral (61-B3) (A.P.C.-111) (61-C3, b**, c***)
I. Sacrococcygeal dislocation 1. Bilateral Bl (open book, exter- I. Extrasacral on both sides
(61-A3.1) nal rotation) (A.P.C.-II) (61-B3.1) (61-C3.1)
(I) bilateral sacroiliacjoint anteri- (at) ilium; (a2) S.I. joint, transiliac
or disruption fracture/ dislocation; (a3) S.I. joint,
(2) bilateral sacral fracture transsacral fracture/ dislocation; (a4)
(3) unilateral partial SI joint dis- S.I. joint dislocation
ruption/contralateralsacralfracture
(c***)
2. Sacral one side, extra sacral

other side (61-C3.2, b**, c***)
2. Sacrum undisplaced (61-A3.2) 2. Bl and B2 (L.P.C.-llI) (61-B3.2, (a1)sacral ala; (a2) sacral foraminal;
a* , b** , c*** ) (a3) sacral medial to foramen
~
~( P)'
").('
") ("
I
\::::/~
3. Bilateral B2 (61-B3.3, a*, b** 3. Sacral both sides (6l-C3.3, c***)

c***) (a) a1)lateral alar; a2)foraminal; a3)
medial
(b) bl) lateral alar; a2)foraminal; a3)
medial
3. Sacrum displaced (61-A3.3)
*a: Ipsilateral posterior pelvic lesion:

a1) sacroiliac joint anterior disruption; a')
sacral fracture; a3) anterior compression
fracture sacrum; a') partial sacroiliac joint
fracture/subluxation; as) incomplete poste- **b: Contralateral pelvic lesion:
rior iliac fracture.
bl) ilium; b') sacroiliac joint, transiliac frac-
**b: Contralateral posterior pelvic lesion:
ture dislocation; b') sacroiliac joint,
bl) sacroiliac joint anterior disruption; b')
transsacral fracture dislocation; b') sacroil-
sacral fracture; b3) anterior compression
iac joint, pure dislocation.
fracture sacrum; b') partial sacroiliac joint
***c: Anterior pelvic lesion:
fracture/subluxation; bS)incomplete poste- c1)unilateral pubis/rami fracture, ipsilater-
rior iliac fracture.
al: c2) unilateral pubis/rami fracture, con-
***c: Anterior pelvic lesion:
tralateral; c') bilateral pubis/rami fracture;
c1)unilateral pubis/rami fracture, ipsilater-
c') symphysis pubis disruption, pure < 2.5
al: c') unilateral pubis/rami fracture, con-
cm; c') symphysis pubis disruption, pure >
tralateral; c3) bilateral pubis/rami fracture;
c') symphysis pubis disruption, pure < 2.5 2.5 cm; c') symphysis pubis disruption,
cm; CS)symphysis pubis disruption, pure > pure, locked; c') symphysis and ipsilateral
pubis/rami fracture (tilt); c') symphysis and
2.5 cm; c6) symphysis pubis disruption,
contralateral pubis/rami fracture; c') sym-
pure, locked; c7) symphysis and ipsilateral
physis and bilateral pubis/rami fracture; c1O)
pubis/rami fracture (tilt); c') symphysis and
no anterior lesion.
contralateral pubis/rami fracture; c') sym-
physis and bilateral pubis/rami fracture; dO)
no anterior lesion.
A3 B3 C3

PELVIS 71

PELVIS (6) Acetabulum (62) A. Partial articular, one column
(62-A)
Modifiers to describe articular
surfaces:
al) femoral head subluxation,
anterior; a2) femoral head sublux-
ation, medial; al femoral head
subluxation, posterior.
§I) femoral head dislocation, an-
terior; §2)femoral head dislocation,
medial; §3) femoral head disloca-
tion, posterior.
XI) acetabular surface, chondral
lesion; X2) acetabular surface, im-
B. Partial articular, transverse
pacted.
01) femoral head, chondralle- (62-B)
sion; 02) femoral head, impacted;
03) femoral head, osteochondral
fracture.
El) intraarticular fragment re-
quiring surgical removal.
01)non-displaced fracture of the
acetabulum.
C. Complete articular, both

columns (62-C)
J Orthap 17auma, Val. 10, Suppl. 1, 1996

72 PELVIS
Groups:
Pelvis, acetabulum, partial articu- Pelvis, acetabulum, partial articu- Pelvis, acetabulum,completeartic.
lar, one column (62-A) lar, transverse (62-8) ular, both columns (62-C)
1. Posterior wall (62-Al) 1.Transverse (62-81) I. High (62-Cl)
2. Posterior column (62-A2) 2. T-shaped (62-82) 2. Low (62-C2)
,~
3. Anterior (62-A3) 3. Anterior column, posterior 3. Involving sacroiliac joint

hemitransverse (62-B3) (62-C3)
A B c
J Orthav Trauma. Val. 10. Suvvl. 1996
PELVIS 73

Pelvis, acetabulum, partial articu- Pelvis, acetabulum,partial articu- Pelvis, acetabulum,complete,both
lar, one column posterior wall lar, transverse(62-Bl) columns high (62-Cl)
(62-A1) I. Infratectal (62-Bl.l, a*) I. Each column simple (62-Cl.l)
I. Pure fracture dislocation, one
fragment (62-A1.1)
(1) posterior
(2) posterior superior
(3) posterior inferior
2. Juxtatectal (62-Bl.2, a*) 2. Posterior column simple, ante-

rior column multifragmentary
(62-Cl.2)
2. Pure fracture dislocation, mul-

tifragmentary (62-A1.2, a*)
(1) posterior
3. Transtectal (62-Bl.3, a*)
3. Posterior column and posteri-

or wall (62-Cl.3, a**, b*)
3. Fracture dislocation with mar-

ginal impaction (62-Al.3, a*)
(1) posterior
At Bl Cl

74 PELVIS
Pelvis, acetabulum,partial articu- Pelvis, acetabulum, partial articu- Pelvis, acetabulum, complete ar-
lar, one column posterior column lar, transverse T-type (62-B2) ticular, both columns low (62-C2)
(62-A2) 1. Infratectal (62-B2.1, a*) I. Each column simple (62-C2.1)
1. Through ischium (62-A2.1) (I) stem posterior
(2) stem through obturator foramen
(3) stem anterior
2. Posterior column simple, ante-

2. Through obturator ring rior column multifragmentary
(62-A2.2) (62-C2.2)
( 1) preserving tear drop 2. Juxtatectal (62-B2.2, a*)
(2) involving tear drop (1) stem posterior
(2) stem through obturator foramen
(3) stem anterior
3. Posterior column and posteri-

or wall (62-C2.3, a**, b*)
3. Associated with posterior wall
(62-A2.3, a*)
( 1) pure fracture dislocation: .1 ) 3. Transtectal (62-B2.3, a*)
posterior; .2) posterior superior; .3) (1) stem posterior
posterior inferior (2) stem through obturator foramen
(2) with marginal impaction: .1) (3) stem anterior
posterior; .2) posterior superior; .3)
posterior inferior
**a: a1) anterior column in one fragment; a')

anterior column in two fragments; a') ante-
rior column in more than two fragments.
*b: bl) posterior wall, single fragment; b') and
posterior wall, multifragmentary, without
impaction; b') and posterior wall, multi-
fragmentary, with marginal impaction.
*a: a1)pure transverse; a') and posterior wall,

single fragments; a') and posterior wall, mul-
tifragmentary; a') and posterior wall, multi-
*a: a]) one fragment; a') two fragments; a') fragmentary with marginal impaction.
more than two fragments.
A2 B2 C2

PELVIS 75
Pelvis, acetabulum, partial articu- Pelvis, acetabulum,partial articu- Pelvis, acetabulum, complete ar-
lar, one column anterior (62-A3, lar, transverseposterior hemitrans- ticular, both columns involving S.I.
a**) verse, anterior column (62-B3) joint (62-C3)
1.Anterior wall (62-A3.1) 1.Anterior wall (62-B3.1) 1.Anterior wall (62-C3.1)
(a1) anterior column simple, high
(a2) anterior column simple, low
(a3) anterior column multifrag-
mentary, high
(a4) anterior column multifrag-
mentary, low
2.Anterior column, high (fracture 2. Anterior colnmn high (62-B3.2,

to iliac crest) (62-A3.2) a**)
2. Posterior column multifrag-

mentary, anterior column high
(62-C3.2, a***, b****)
3. Low (fracture to anterior bor- 3. Anterior column low (62-B3.3,

der) iliac crest (62-A3.3) a**)
3. Posterior column multifrag-

mentary, anterior column low
(62-C3.3, a***, b****)
**a: at) anterior column in one fragment; a') **a: a1)anterior column in one fragment; a')
anterior column in two fragments; a3) an- anterior column in two fragments; a') ante-
terior column in more than two fragments. rior column in more than two fragments. "~
***a: a1)anterior column simple; a') anteri-

or column multi fragmentary.
****b: b1) pure separation; b') and posterior
wall, single fragment; b3) and posterior wall,
multifragmentary without impaction; b')
and posterior wall, multifragmentary with
marginal impaction
A3 B3 C3

76 CLAVICLE
CLAVICLE
BONE: Location: Group:

CLAVICLE Medial end (05) Clavicle medial end, metaphysis
(05-A)
Clavicle dislocated,isolated (040) Type: I. Extra-articular impacted
(I) Medial end (040.1) A. Clavicle medial end, metaph- (05-Al)
(2) Lateral end (040.2) ysis (05-A)
;:;:
2. Extra-articular displaced
(05-A2)
3. Extra-articular multifrag-
mentary (05-A3)
JOrthap Trauma, Val. 10, Suppl. 1, 1996

CLAVICLE 77
BONE: Location: Type:

CLAVICLE Diaphysis (06) A. Clavicle, diaphysis, simple
(06-A)
'"--"' B. Clavicle, diaphysis, wedge

(06-B)
:]
C. Clavicle, diaphysis, complex
(06-C)

78 CLAVICLE
Groups:
Clavicle, diaphysis, simple (06-A) Clavicle, diaphysis,wedge (06-B) Clavicle,diaphysis,complex(06-C)
I. Spiral (06-Al ) 1. Spiral wedge (06-Bl) 1. Spiral (06-Cl)
2. Oblique (06-A2) 2. Bending wedge (06-B2) 2. Segmental (06-C2)
3. Transverse (06-A3) 3. Fragmented wedge (06-B3) 3. Irregular (06-C3)
A B c
J OrthoD Trauma. Vol. 10. SuDD1.1. 1996
CLAVICLE 79
BONE: Location: Type:

CLAVICLE Lateral end (07) A. Clavicle, lateral end, extra-ar-
ticular metaphysis (07-A)
B. Clavicle, lateral end, intra-ar-

ticular (07-B)
, Orthap Trouma, Val. 10, Suppl. 1, 1996

80 CLAVICLE
Groups: Modifiers:
Clavicle, lateral end, extra-articu- Clavicle, lateral end, intra-articular .10) anterior dislocation; .11 )
lar metaphysis (07-A) (07-B) posterior dislocation; .22) scapu-
I. Impacted (07-AI) I. With slight displacement (no lothoracic dislocation; .23) AC joint
dislocation) (07-Bl) separation.
2. Displaced (C-C ligament in-

tact) (07-A2) 2. Wedge fracture with disloca-
tion (07-B2)
3. Multifragmentary (C-C liga-

ment intact) (07-A3) 3. Multifragmentary fracture
with dislocation (07-B3)
J OrthalJ Trauma. Val. 10. SulJlJl. 1. 1996

SCAPULA 8]
SCAPULA

SCAPULA (09) Scapula (09) A. Scapula, extra-articular (09-A)
B. Scapula, articular glenoid (09-

B)

82 SCAPULA
Groups: Subgroups and Qualifications:

At. Scapula, extra-articular, Scapula, extra-articular, processes Scapula,articular glenoid, impact-
processes (09-Al ) (09-AI) ed (09-Bl)
1. Acromium, simple (09-AI.I) 1.Anterior rim (09-Bl.l)
Bl. Scapula, articular glenoid, im-
pacted (09-81)
2. Acromium, multifragmentary 2. Posterior rim (09-Bl.2)

(09-Al.2)
3. Inferior rim (09-81.3)

3. Coracoid process (09-Al.3)
At B1
J Orthop Troumo, Vol. 10, Suppl. 1, 1996
SCAPULA 83

A2. Scapula, extra-articular, body Scapula, extra-articular, body Scapula, intra-articular glenoid,
(09-A2) (09-A2) non-impacted (09-B2)
I. Simple (09-A2.l) 1.Anterior rim free (09-B2.1)
B2. Scapula, intra-articular gle-
noid, non-impacted (09-B2)
2. Multifragmeutary (09-A2.2) 2. Posterior rim free (09-B2.2)
3. Glenoid neck (09-A2.3) 3. Anterior/posterior with glenoid

neck (09-B2.3)
A2 B2
84 SCAPULA

A3. Scapula, extra-articular, com- Scapula, extra-articular, complex Scapula, intra-articular glenoid,
plex (09-A3) (09-A3) complex (09-B3)
I. Glenoid neck plus body (09-A3.I) I. Multifragmentary intra-artic-
B3. Scapula, intra-articular gle- ular (09-B3.1)
noid, complex (09-B3)
2. Glenoid neck plus simple clav-

icle fracture (09-A3.2) 2. Multifragmentary with glenoid
neck and/or body (09-B3.2)
3. Glenoid neck plus multifrag-

mentary claviclefracture (09-A3.3) 3. Multifragmentary with clavi-
cle fracture (09-B3.3)
J Orthop Trauma, Vol. 10, Suppl. 1996

A3 B3
CARPUS 85
CARPUS

CARPUS (24) Carpus (24) A. Common carpal fracture dis-
location (24-A)
Modifiers for carpal bones:
LU, lunate; CA, capitate; TO, B. Carpal fractures (24-B)
trapezoid; PI, pisiform; MC,
metacarpal, HA, hamate; TN, c. Scaphoid fractures (isolated)
trapezium; TQ, triquetrum; SC, (24-C)
scaphoid.
86 CARPUS
Groups, Subgroups and Qualifi-

cations:
Common carpal fracture disloca- Vertical (24-BI) Avulsions (24-Cl)
tion (24-Al) I. Simple/avulsion (24-B I.I )
I. Transscaphoid perilunate dis-
location (24-Al.l)
2. Complex (24-Bl.2)
2. Transscaphoid perilunate dis-

location with associated other
carpal fractures (24-Al.2)
3. Perilunate dislocation with as-

sociatedother carpal fracture ex-
cept scaphoid (24-Al.3)
CARPUS 87

B2. Oblique (24-82) Oblique (24-B2) Horizontal, 1ransverse/oblique
(24-C2)
I. Simple/avulsion (24-B2.1 ) I. Distal third (24-C2.1)
C2. Horizontal, transverse/
oblique (24-C2)
2. Complex (24-B2.2)
2. Middle third (24-C2.2)
3. Proximal (24-C2.3)
88 CARPUS

B3. Transverse (24-B3) Transverse (24-B3)
I. Transverse (24-B3.1 )
C3. Vertical/Multifragmentary
(24-C3)
2. Simple/avulsion (24-83.2)
' v
3. Complex (irreducible) (24-B3.3)
~(
B3
METACARPALS 89
METACARPALS

METACARPAL (25) Metacarpal (25) 1. Metacarpal head (25--1)
Modifiers for metacarpals: 2. Metacarpal diaphysis (25--2)

T, thumb; I, index; M, middle;
R, ring; L, little. 3. Metacarpal base (25--3)

90 METACARPALS
Groups:
I. Metacarpal head, extra-artic- I. Metacarpal head, articular I. Metacarpal head, articular/
ular (25-Al ) (25-BI) extra-articular (25-Cl)
2. Metacarpal diaphyseal (25-B2)
3. Metacarpal base, extra-artic- 3. Metacarpal base, articular 3. Metacarpal base, articular/

ular (25-A3) (25-B3) extra-articular (25-C3)
A B c
METACARPALS 91

Metacarpal head, extra-articular Metacarpalhead,articular (25-Bl) Metacarpal head, articular/extra-ar-
(25-Al) I. Oblique/spiral (25-Bl.l) ticular (25-C I )
I. Simple (25-Al.l) I. Articular simple/metaphyseal
simple (25-Cl.l)
2. Articular simple/metaphyseal
multifragmentary (25-C 1.2)
2. Sagittal (25-Bl.2)
2. Metaphyseal wedge (25-Al.2)
~
3. Multifragmentary articular/
metaphyseal simple (25-Cl.3)
3. Coronal (25-81.3)
3. Metaphyseal complex (25-Al.3)
and metaphysis (25-Cl.4)
Pf<I
At B1 Cl

92 METACARPALS
Metacarpal diaphyseal (25-B2) 4. Complex (25-B2.4)

I. Spiral/oblique (25-B2.1)
2. Transverse (25-B2.2)
3. Simple wedge (25-B2.3)
B2 B2
J Orthap Trauma. Val. 10, Suppl. 1, 1996

METACARPALS 93
Metacarpal base, extra-articular Metacarpalbase,articular (25-B3) Metacarpal base, articular/extra-ar-

(25-A3) 1.Avulsion (25-B3.l) ticular (25-C3)
I. Simple (25-A3.1) I. Articular/metaphyseal simple
(25-C3.1)
2. Articular simple/metaphyseal
multifragmentary (25-C3.2)
2. Depression (25-B3.2)
(25-A3.2)
y
3. Articular multifragmentaryl
metaphyseal simple (25-C3.3)
3. Split depression (25-B3.3)
and metaphyseal (25-C3.4)
A3 B3 C3
~
94 PHALANX
PHALANX

PHALANX (26) Phalanx (26) A. Extra-articular (26-A)
Modifiers for phalanx: 8. Articular and diaphyseal

Tl and T2, thumb 1/2; N1, N2 (26-8)
and N3, index 1/2/3; Ml, M2 and
M3, middle 1/2/3; Rl~ R2 and R3, C. Complete articular (26-C)
ring 1/2/3; L1, L2 and L3, little
1/2/3.
J Orthap Irauma, Val. 10, Suppl. 1, 1996

PHALANX 95
Groups:
Phalanx, proximal extra-articu- Phalanx, proximal partial articu- Phalanx, proximal complete ar-
lar (26-Al) lar (26-Bl) ticular (26-CI)
Phalanx diaphyseal (26-A2)
Phalanx, distal extra-articular Phalanx, distal partial articular Phalanx, distal complete articu.
(26-A3) (26-B3) lar (26-C3)
A B c
96 p HALANX

Phalanx, proximal extra-articular Phalanx, proximal partial articular Phalanx,proximal completearticu-
(26-Al) (26-BI) lar (26-Cl)
I. Simple (26-Al.l) 1. Unicondylar (26-BI.l) I. Simple articular/metaphysis
simple (26-C1.1)
2. Multifragmentary (26-AI.2) 2. Bicondylar (26-BI.2)

2. Simple articular/metaphysis
multifragmentary (26-C 1.2)
3. Multifragmentary articular and

metaphysis (26-C 1.3)
At Bl Cl
J Orthop Trauma, Vol. 10, Supp[ 1, 1996
PHALANX 97
Phalanx diaphyseal (26-A2)

1. Spiral/oblique (26-A2.1) 4. Multifragmentary (26-A2.4)
3. Simple wedge(26-A2.3)
A2 A2
J Orthap 1Yauma, Val. 10, Suppl. 1, 1996
98 PHALANX
Phalanx, distal extra-articular Phalanx, distal partial articular Phalanx, distal complete articular
(26-A3) (26-B3) (26-C3)
I. Spiral (26-A3.l) I. Unicondylar (26-B3.1) I. Simple (26-C3.1)
2. Multifragmentary (26-A3.2) 2. Bicondylar (26-B3.2) 2. Complex (26-C3.2)

PATELLA 99
PATELLA

PATELLA (45) Patella (45) A. Patella extra-articular (45-A)
B. Partial articular; extensor

mechanism intact (45-B)
L M
C. Complete articular; disrupt-

ed extensor mechanism ( 45-C)

100 PATELLA
Groups:
Patella, extra-articular (45-A) Patella, partial articular; extensor Patella, complete articular; dis-
I. Patella, extra-articular, avul- mechanismintact (45-B) rupted extensor mechanism (45-C)
sion (45-Al ) I. Patella, partial articular, ver- I. Patella, articular, transverse
tical, lateral (45-Bl) (45-Cl)
2. Patella, partial articular, ver- 2. Patella, articular, transverse

tical, medial (45-B2) plus second fragment ( 45-C2)
2. Patella, extra-articular isolat- -

ed body (45-A2)
L M
3. Patella, partial articular, mul- 3. Patella, articular, complex

tifragmentary (Stellate) ( 45-B3) ( 45-C3)
A B c
PATELLA 101

Patella, extra-articular, avulsion Patella, partial articular, vertical, Patella, complete articular, trans-
(45-Al) lateral (45-Bl) verse (45-Cl)
I. Simple (45-Bl.l) I. Middle (45-Cl.l)
j~~j
2. Proximal ( 45-C 1.2)

"r-o-
"
/! "
2. Multifragmentary (45-Bl.2)
3. Distal (45-Cl.3)
At B1 Cl
JOrthopTrouma, Vol.10, Suppl.1, 1996

102 PATELLA
Patella extra-articular, isolated body Patella, partial articular, vertical, Patella, articular, transverse plus
(45-A2) medial (45-B2) secondfragment (45;.C2}
I. Simple (45-A2.l) 1. Simple (45-B2.1) I. Middle (45-C2.l}
2. Proximal ( 45-C2.2)
2. Multifragmentary (45-A2.2) 2. Multifragmeutary (45-B2.2)
3. Distal (45-C2.3)
A2 B2 C2
J Orthap Trouma, Val. 10, Suppl. 1, 1996

PATELLA 103
Patella, partial articular, multifrag- Patella,articular, complex (45-B3)

mentary (Stellate) {45- B3 ) 1.3 fragments (45-C3.1)
2. More than 3 fragments (45-C3.2)
3. Non-reconstructible (45-C3.3)
B3 C3
J Orthop Trouma, Vol. 10, Suppl. 1, 1996

104 TALUS
TALUS

TALUS (72) Talus (72) A. Talus, extra-articular (72-A)
B. Talus, partial articular (72-8)
c. Talus, articular (72-C)

TALUS 105
Groups:
Talus, extra-articular (72-A) Talus, partial articular (72-B) Talus, articular (72-C)
I. Talus, extra-articular, neck I. Talus, partial articular, lateral I. Talus, articular, simple (72-Cl)
(72-Al) half body (72-Bl)

(1) undisplaced
(2) displaced
2. Talus, partial articular, medi- 2. Talus, articular, multifrag-

2. Talus, extra-articular, avulsions al half body (72-B2) mentary (72;.C2)
(72-A2)
3. Talus, partial articular, coro-

nal (72-B3)
A B c
J Orthop Trauma, f()l. 10, Suppl. 1, 1996
106 TALUS

Talus, extra-articular, neck (72-Al) Talus,partial articular, lateral half Talus, articular, simple (72-Cl)
I. Simple (72-Al.l) body (72-Bl) I. Undisplaced (72-Cl.l)
I. Split (72-Bl.l)
2. Multifragmentary (72-Al.2)
2. Depression (72-Bl.2) 2. Displaced (72-Cl.2)
3. Associated with dislocation of

talus (72-AI.3)
(I) body
(2) body and head
3. Split/depression (72-Bl.3)
At Bl Cl
TALUS 107
Talus, extra-articular, avulsions Talus,partial articular, medial half Talus,'articular, multi fragmentary
(72-A2) body (72-B2) (72-C2)
I. Superior, from neck, ankle cap- I. Split (72-B2.1) I. Undisplaced (72-C2.1)
sule (72-A2.1 )
2. Lateral process (72-A2.2)

2. Depression (72-B2.2) 2. Displaced (72-C2.2)
3. Posterior process (72-A2.3)
3. Split/depression (72-B2.3)
A2 B2 C2
JOrthopTrauma, Vol.10,Suppl.1, 1996

108 TALUS
Talus, partial articular, coronal

(72-B3)
I. Split (72-B3.l)
3. Splitldepression (72-B3.3)
B3

CALCANEUS 109
CALCANEUS

CALCANEUS (73) Calcaneus (73) A. Calcaneus, extra-articular
(73-A)
B. Calcaneus, isloated body

(73-B)
C. Calcaneus, articular (73-C)

110 CALCANEUS
Groups:
Calcaneus, extra-articular (73-A) Calcaneus, isolated body (73-B) Calcaneus, articular (73-C)
I. Calcaneus, extra-articular, 1. Calcaneus, isolated body, I. Calcaneus, articular, two part
avulsion (73-Al) undisplaced (73-B 1) (73-CI)
2. Calcaneus, isolated body, dis- 2. Calcaneus,articular, three part

placed (73-B2) fracture (73-C2)
3. Calcaneus,isolated body, frac- 3. Calcaneus, articular, 4 plus

ture into calcaneal-cuboid joint parts (73-C3)
(73-B3)
(1) undisplaced
(2) displaced
A B c
CALCANEUS 111

Calcaneus, extra-articular, avulsion Calcaneus, isolated body, undis- Calcaneus, articular, two part
(73-Al) placed (73-Bl) (73-CI)
1.Anterior process (73-Al.l) I. Simple (73-Bl.l) I. Posterior facet fracture, later-
al (73-CI.I)
---"
J'~
\\J
))
2. Medial process (sustentacu-
"-/
lum) (73-AI.2)
2. Posterior facet fracture, cen-

2. Multifragmentary (73-Bl.2)
tral (73-Cl.2)
'--' ~
v
3. Posterior tuberosity (73-Al.3)
Jill 3. Posterior facet fracture, medi-

al (73-Cl.3)
At B1 Cl
J Orthop Trauma, fVl. 10, Suppl. 1, 1996

112 CALCANEUS
Calcaneus, isolated body, displaced Calcaneus, articular, three part frac-

(73-B2) ture (73-C2)
I. Decreased tuber angle but > 00 I. Posterior facet fracture, later-
(73-B2.1) al-central (73-C2.1 )
2. Flat tuber angle (00) (73-82.2) 2. Posterior facet fracture, later-

al-medial (73-C2.2)
\t
1 !
i
3. Negative tuber angle « 00) 3. Posterior facet fracture, cen-

(73-B2.3) tral-medial (73-C2.3)
(91
I!
B2 C2
~
CALCANEUS 113
Calcaneus, isolated body, fracture Calcaneus, articular, 4 plus parts

into calcaneal-cuboidjoint (73-B3) (73-C3)
I. Split (73-B3.1)
B3 C3

]]4 NAVICULAR
NAVICULAR

NAVICULAR (74) Navicular (74) A. Navicular, extra-articular (no
joint involved) (74-A)
B. Navicular, partial articular

(talo-navicular joint) (74-8)
C. Navicular, articular (both

joints involved) (74-C)

NAVICULAR 115
Groups:
Navicular, extra-articular (no joint Navicular, partial articular (talo- Navicular, articular (bothjoints in-
involved) (74-A) navicular joint) (74-8) volved) (74-C)
1. Navicular, extra-articular avul- I. Navicular, partial articular, I. Navicular, articular (both sur-
sion (74-Al) sagittal lateral half (74-81) faces) multifragmentary (74-Cl)
(1) undisplaced
2. Navicular, extra-articular, coro- 2. N avicular, partial articular, (2) displaced
nal body split (74-A2) sagittal medial half (74-B2)
3. Navicular, partial articular,

horizontal fracture (74-B3)
3. Navicular, extra-articular, mul-

tifragmentary body (crush)
(74-A3)
A B c
J Orthop Trauma, Vol. 10, SuppL 1, 1996
116 NAVICULAR

Navicular, extra-articular avulsion Navicular, partial articular, sagittal Navicular, articular (both surfaces)
(74-Al) lateral half(74-Bl) multifragmentary (74-CI)
1.Anterior surface (74-Al.l) I. Split (74-Bl.l)
2. Medial surface (74-Al.2)
2. Depression (74-Bl.2)
3. Miscellaneons (74-Al.3)
At Bl Cl

NAVICULAR 117
Navicular, extra-articular, coronal Navicular, partial articular, sagittal

body split (74-A2) medial half (74-B2)
I. Split (74-B2.1)
A2 B2

]]8 NAVICULAR
Navicular, extra-articular, multi- Navicular, partial articular, hori-

fragmentary body (crush) (74-A3) zontal fracture (74.,83)
I. Split (74-83.1)
A3 B3
JOrthap Trauma, VaL 10, SuppL 1,1996

CUNEIFORMS 119
CUNEIFORMS

CUNEIFORMS (75) Cuneiforms (75) A. Cuneiform, extra-articular (no
(1) medial
(2) intermediate B. Cuneiform, partial articular
(3) lateral (one joint involved) (75-B)
C. Cuneiform, articular (both

joints involved) (75-C)
J Orthap n-auma, Val. 10, Suppl. 1,1996

120 CUNEIFORMS
Groups:
Cuneiform, extra-articular (no joint Cuneiform, partial articular (one Cuneiform, artic ular (both joints
involved) (75-A) joint involved) (75-B) involved) (75-C)
1. Cuneiform, extra-articular I. Cuneiform, partial articular, I. Cuneiform, articular, multi-
avulsion (75-Al) sagittal (75-Bl) fragmentary (75-Cl)
2. Cuneiform, extra-articular 2. Cuneiform, partial articular,

coronal (75-A2) horizontal (75-B2)
3. Cuneiform, extra-articular
multifragmentary (75-A3)
A B c
JOrthovTrouma. Vol.IO. Suvvl.1. 1996
CUNEIFORMS 121

Cuneifonn, extra-articular avulsion Cuneiform, partial articular, sagit- Cuneiform, articular, multifrag-
(75-Al) tal (75-Bl) mentary (75-Cl)
1.Anterior (75-Al.l) I. Split (75-Bl.l)
2. Medial (75-Al.2)
3. Plantar (75-Al.3)
3. Splitldepression (75-BI.3)
At Bl Cl
J Orthap lrauma, Val. 10, Suppl. 1, 1996

122 CUNEIFORMS
Cuneiform, extra-articular coronal Cuneiform, partial articular, hori-

(75-A2) zontal (75-82)
I. Simple split (75-A2.1) I. Split (75-82.1)
::::?
A2 B2

CUBOID 123
CUBOID

CUBOID (76) Cuboid (76) A. Cuboid, extra-articular (no
B. Cuboid, partial articular (one

joint involved) (76-B)
(1) calcaneal-cuboidjoint
(2) cuboid-tarsal joint
C. Cuboid, articular (both joints

involved) (76-C)
J Orthop Trauma, fVl. 10, Suppl. 1, 1996

124 CUBOID
Groups:
Cuboid, extra-articular (no joint in- Cuboid, partial articular (onejoint Cuboid, articular (both joints in-
volved) (76-A) involved) (76-B) volved) (76-C)
I. Cuboid, extra-articular, avul- 1. Cuboid, partial articular, sagit- I. Cuboid, articular, multifrag-
sion (76-AI) tal (76-Bl) mentary (76-CI)
(I) undisplaced
2. Cuboid, extra-articular, coro- 2. Cuboid, partial articular, hor- (2) displaced
nal (76-A2) izontal (76-B2)
3. Cuboid, extra-articular, multi-

fragmentary (crush) (76-A3)
A B c
Orthap Trauma, Val. 10, Suppl. /996
CUBOID 125

Cuboid, extra-articular, avulsion Cuboid, partial articular, sagittal Cuboid, articular, multifragmentary
(76-Al) (76-BI) (76-Cl)
I. Anterior (76-Al.l ) I. Split (76-Bl.l)
2. Lateral (76-Al.2)
--
2. Depression (76-81.2)
3. Plantar (76-Al.3)
"'-'
3. Split/depression (76-81.3)
At Bl Cl

126 CUBOID
Cuboid, extra-articular, coronal Cuboid, partial articular, horizon-

(76-A2) tal (76-B2)
I. Split (76-B2.1)
F
3. Split/depression (76-82.3)
'---'
":;:;::;;::
A2 B2
J Orthop Trauma, Vol. 10. Suppl. 1. 1996

METATARSALS
METATARSALS

METATARSALS (81) Metatarsals (81) I. Metatarsal proximal (81--1 )
Modifiers for metatarsals: 2. Metatarsal diaphysis (81--2)

T, thumb toe (great) (I); N,
index toe (2); M, middle toe (3); R, 3. Metatarsal distal (81--3)
ring toe (4); L, little toe (5).

128 METATARSALS
Groups:
I. Metatarsal, proximal extra-ar- I. Metatarsal, proximal partial ar- I. Metatarsal,proximal articular
ticular (81-Al) ticular (81-Bl) (81-Cl)
(1) unicondyle medial
(2) unicondyle lateral
2. Metatarsal, diaphysis simple 2. Metatarsal, diaphysis wedge 2. Metatarsal, diaphysis complex

(81-A2) (81-82) (81-C2)
3. Metatarsal, distal partial artic-

ular (81-B3)
3. Metatarsal, distal extra-artic- (I) unicondyle lateral
3. Metatarsal, distal articular
ular (81-A3) (2) unicondyle medial
(SI-C3)
A B c
J Orthap Trauma, VaL 10, SuppL 1996
METATARSALS 129

Metatarsal, proximal extra-articu- Metatarsal,proximal partial articu- Metatarsal, proximal articular
lar(81-AI) lar (81-BI) (8l-Cl)
1. Avulsions (81-Al.l) I. Split (81-Bl.l) I. Simple articular metaphysis
(8l-Cl.l)
2. Simple (81-Al.2)
2. Simple articular, multifrag-

meutary metaphysis (81-CI.2)
(1) wedge
(2) complex
(81-Cl.3)
At Bl Cl
~
130 METATARSALS
Metatarsal,diaphysis simple (8l-A2) Metatarsal, diaphysis wedge (81-B2) Metatarsal, diaphysis complex
I. Spiral (81-A2.1) I. Spiral (81-B2.1) (8l-C2)
I. Segmental(8l-C2.l)
2. Bending (81-B2.2)
3. Fragmented (81-B2.3)
2. Oblique (81-A2.2)
A2 B2 C2

METATARSALS 131
Metatarsal, distal extra-articular Metatarsal, distal partial articular Metatarsal, distal articular (8l-C3)
(8l-A3) (81-B3) I. Simple articular/metaphysis
1. Avulsion (81-A3.l) I. Split (81-B3.1) (8l-C3.l)
2. Simple (81-A3.2) r'

~
- 2. Simple articular/multifragmen-
tary metaphysis (81-C3.2)
(81-C3.3)
A3 B3 C3

132 PHALANX
PHALANX

PHALANX (82) Phalanx (82) 1. Phalanx proximal (82--1 )
Modifiers for phalanges:

Tl!T2, thumb toe (1/2); Nl/N2/
N3, index toe (1/2/3); M1/M2/M3,
middle toe (1/2/3); R1/R2/R3, ring
toe (1/2/3); Ll/L2/L3, little toe (1/
2/3).
2. Phalanx diaphysis (82--2)
3. Phalanx distal (82--3)

PHALANX 133
Groups:
I. Phalanx, proximal extra-artic- 1. Phalanx, proximal partial ar- I. Phalanx, proximal articular
ular (82-Al) ticular (82-Bl) (82-Cl)
(1) split
(2) depression 2. Phalanx, diaphysis complex
(3) split depression
(82-C2)
2. Phalanx, diaphysis simple

(82-A2)
2. Phalanx, diaphysis wedge

3. Phalanx, distal articular (82-C3)
(82-B2)
3. Phalanx, distal extra-articular
(82-A3)
3. Phalanx, distal partial articu-

lar (82-B3)
A B c
134 PHALANX

Phalanx, proximal extra-articular Phalanx,proximal partial articular Phalanx, proximal articular (82-Cl)
(82-AI) (82-BI) I. Simple articular/metaphysis
1. Avulsions (82-Al.l) I. Unicondyle medial (82-BI.l) (82-CI.l)
2. Simple (82-Al.2) 2. Unicondyle lateral (82-Bl.2)
2. Simple articular/multifrag-
mentary metaphysis (82-Cl.2)
(82-CI.3)
(I) simple metaphysis
(2) multifragmentarymetaphysis
At Bl Cl

PHALANX 135
Phalanx, diaphysis simple (82-A2) Phalanx, diaphysis wedge (82-B2) Phalanx,diaphysiscomplex(82-C2)

I. Spiral (82-A2.1) 1. Spiral (82-B2.1) I. Segmental (82-C2.l )
2. Bending (82-B2.2) 2. Irregular (82-C2.2)
2. Oblique (82-A2.2)
3. Transverse (82-A2.3) 3. Fragmented (82-B2.3)
A2 B2 C2

136 PHALANX
Phalanx, distal extra-articular Phalanx, distal partial articular Phalanx, distal articular (82-C3)
(82-A3) (82-B3) I. Simple articular/metaphysis
1.Avulsion (82-A3.1) I. Unicondyle medial (82-B3.1) (82-C3.1)
2. Simple (82-A3.2) 2. Simple articular/multifrag-

mentary metaphysis (82-C3.2)
(82-C3.3)
2. Unicondyle lateral (82-B3.2)
A3 B3 C3
J Orthop Trouma, Vol. 10, Suppl. 1, 1996

DISLOCATIONS 137
DISLOCATIONS (D) DISLOCATION DIRECTION DISLOCATIONS

MODIFIERS
Sternoclavicular(04-D 1); Acro- JOINT: Sternoclavicular joint
mioclavicular (04-D2); Gleno- Anterior (10); Posterior (11); (04-DI)
humeral (10-D); Elbow (20-D). Medial (12); Lateral (13); Antero-
Carpus (24-D); Metacarpal- medial (14); Anterolateral(15); Pos- JOINT: Acromioclavicular joint
carpal (25-D); Metacarpal-pha- teromedial(16); Posterolateral(17); (04-D2)
langeal (25-D2); Phalangeal(26- Divergent (18).
D). 1. AC joint capsule torn cc liga-
Hip (30-0); Knee (40-0); Patel- ment intact (04-D2.1)
lo-femoral (45-0); Proximal tibio-
fibular (46-0). 2. AC joint capsule torn cc liga-
Syndesmotic rupture (70-0); ment torn (04-D2.2)
Tibio talar (ankle) (71-0); Subta-
lar (72-0); Mid tarsal (choparts) 3. Irreducible (04-D2.3)
(77-0); Lisfranc (80-0); Meta-
tarsal, phalangeal(81-0).

138 DISLOCATIONS
JOINT: Glenohumeral joint

(lO-D)
Anterior (lO-DlO) Posterior (10-Dll) Inferior (luxatio, erecta)(10-D18)

DISLOCATIONS 139
JOINT: Elbow (20-D)

Anterior (20-DlO) Lateral (20-D13)
Posterolateral(20-DI7)
Posterior (20-Dll)
Posteromedial (20-DI6) Divergent(20-D18)
Medial (20-D12)

140 DISLOCATIONS
JOINT: Carpal dislocations JOINT: Metacarpal-carpal dis-

(24-D) locations (25-Dl)
Plus modifiers for carpal bone: Modified by metacarpal in-

LU, lunate; CA, capitate; TO, volved:
trapezoid; PI, pisiform; MC, T, thumb; I, index; M, middle;
metacarpal; HA, hamate; TU, R, ring; L, little.
trapezium; TQ, triquetrum; SC,
scaphoid; RC, complete radio-
carpal.
Example: Lunate dislocated
(24-D.LU)
JOrthop Trauma, Vol. 10, Suppl. 1, 1996

DISLOCATIONS 141
JOINT: Metacarpal-phalangeal
dislocation (25-D2)
Radial dislocation (25-D2.0) Volar dislocation (25-D2.2) Volar irreducible dislocation
(25-02.6)
Dorsal irreducible dislocation

(25-D2.7)
Radial irreducible dislocation

(25-D2.8)
u
Ulna irreducible dislocation
(25-D2.9)
Ulnar dislocation (25-D2.1 ) Dorsal dislocation (25-D2.5)
J Orthop Trauma, Vol. 10, SuppL 1, 1996

142 DISLOCATIONS
JOINT: Phalangeal dislocation

(26-D)
Proximal interphalangeal joint

(26-D2)
Distal interphalangeal joint

(26-D3)
Ulnar (26-D3.1) Volar (26-D3.3) Irreducible (26-03.5)
Radial (26-03.2) Dorsal (26-D3.4)
J Orthap Trouma, Val. 10, Suppl. 1, 1996
~
DISLOCATIONS 143
JOINT: Hip (30-D)

Anterior (30-DlO) Posterior (30-Dll) Obturator (30-D30)
/
(
f\~
\\
~"' ~
'-'
/
) ~.\J
J-oj 0,
---
I
,
JOrthopTrauma,Vol.10, Suppl.1, 1996

144 DISLOCATIONS
JOINT: Knee ( 40-D)

Anterior (40-DlO) Medial (40-D12) Anteromedial(40-D14)
Anterolateral (40-D15)
Posteromedial (40-DI6)
Posterolateral(40-D17)
Posterior (40-Dll) Lateral(40-DI3)

DISLOCATIONS 145
Global (complete) no ligament Medial collateral midsubstance Lateral collateral midsubstance

intact (40-D31) tear (40-D33) tear (40-D35)
f
M
Anterior cruciate midsubstance

tear ( 40-D32)
Posterior cruciate ligament mid-

substance tear (40-D34)
Anterior cruciate honey avulsion
(40-D36)
(1) from tibia
(2) from femur
M
t \
M
\
~
\\

146 DISLOCATIONS
Medial collateral ligament bony Posterior cruciate bony avulsion Lateral collateral bony avulsion
avulsion (40-D37) (40-D38) (40-D39)
(1) from tibia
(2) from femur

DISLOCATIONS 147
JOINT: Patello-femoral (45-0) JOINT: Proximal tibio-fibular

dislocations (46-D)
Medial (45-012)
Anterolateral(46-Dl) Posteromedial (46-D2)
Lateral (45-D13) Simple (46-Dl.l) Simple (46-D2.1)
Quadriceps tendon rupture

(45-D49)
Patellar tendon avulsion/tear

(4S-DSO)
( I) bony avulsion
(2) tear
Associated with fibular fracture Associated with fibular fracture

(46-DI.2) (46-D2.2)
Associated with tibia fracture Associated with tibia fracture

(46-Dl.3) (46-D2.3)

148 DISLOCATIONS
Superior (46-D3)
Simple (46-D3.1) Associated with fibula fracture Associated with tibia fracture
(46-D3.2) (46-03.3)
\'I

DISLOCATIONS 149
JOINT: Distal tibio-fibular joint, JOINT: Tibio-talar (ankle) (71-0) JOINT: Subtalar (talo-calcaneal)
syndesmosis disruption with no Anterior (71-010) (72-D)
fracture (70-Dl) Medial (72-D51)
Lateral (72-D52)
Posterior (71-Dll)

150 DISLOCATIONS
JOINT: Mid tarsal (Choparts) JOINT: Tarsal-metatarsal joint JOINT: Metatarsal phalangeal
(77-D) (Lisfranc) (SO-D) (81-DI)
Medial(77-D12) Isolated based on metatarsal JOINT: Proximal interphalangeal

modifier and direction modifier, (81-D2)
Lateral(77-DI3) e.g., anterior dislocation of Ist ray
(80-DlO(T)) JOINT: Distal interphalangeal
(81-D3)
Multiple (Lisfranc dislocation)
Homo lateral (80-D55) Modifiers for (81-01, 02, 03):
.12, medial; .13, lateral; .53, dor-
sal; .54, plantar.
Dorsal (80-D53)
Plantar (80-D54)
Divergent (80-D56)

SPINE 151
SPINE

SPINE (5) Cervical (51) A. Compression injuries of the
body (compressiveforces) (S--A)
Thoracic (52)
B. Distraction injuries of the an-

terior and posterior elements
(tensile forces) (5--B)
Lumbar (53)
C. Multidirectional injuries with

translation affecting the anteri-
or and posterior elements (axial
torque causing rotation injuries)
(5--C)

152 SPINE
Groups:
Vertebral body compression type Anterior or posterior element in- Anterior or posterior element in-
(5--A) jury with distraction (5--B) jury with rotation (5--C)
I. Impaction fractures (5--Al) I. Posterior disruption predomi- I. Rotational wedge, split, and
nantly ligamentous (flexion-dis- burst fractures (5--Cl)
traction injury) (5--BI)
2. Split fractures (5--A2)

2. Flexion subluxation with rota-
tion (5--C2)
2. Posterior disruption predomi-
nantly osseous(flexion-distrac-
tion injury) (5--B2)
3. Burst fractures (5--A3)
3. Rotational shear injuries

3. Anterior disruption through (Holdsworth slice rotation frac-
the disc (hyperextension-shearin- ture) (5--C3)
jury) (5--B3)
A B c
J Orthop Trauma, VoL 10, SuppL 1, 1996
SPINE 153

Vertebral body compression frac- Posterior disruption ligamentous Rotational wedge, split and burst
tures, impaction injury (5--Al) (5--Bl) fractures (5--Cl)
I. End plate impaction (5--Al.l) I. With transverse disruption of I. Rotational wedge fractures
the disc (5--Bl.l) (5--Cl.l)
2. Wedge impaction (5--Al.2)
2. Vertebral body compression 2. Rotational split fractures
3. Vertebral body collapse (5--Al.3) fracture (5--BI.2) (5--Cl.2)
3. Rotational burst fractures

(5-~Cl.3)
Vertebral body compression frac- Posterior disruption osseous(5--82)
tures, split (5--A2) 1. Transverse bicolumn fracture
I. Sagittal (5--A2.1) (5--82.1)
Flexion subluxation with rotation
2. Coronal (5--A2.2) 2. With transverse disruption of (5-~C2)
the disc (5--82.2) I. Flexion-distraction injuries
3. Pincer (5--A2.3) with rotation (5--C2.1)
3. With vertebral body compres-
sion (5--B2.3) 2. B2 with rotation (5--C2.2)
Vertebral body compression burst 3. Hyperextension-shear-rotation

fractures (5--A3) of spine (5--C2.3)
1. Incomplete burst (5--A3.l) Anterior disruption through the disc
(5--B3)
2. Burst-split (5--A3.2) I. Hyperextension-subluxation
(5--B3.1) Rotational shearinjuries (5--C3)
3. Complete burst (5--A3.3) I. Slice (5--C3.1)
2. Hyperextension-spondylolysis
(5--B3.2) 2. Oblique (5--C3.2)
3. Posterior dislocation (5--B3.3)
Bl, B2, B3
J Orthop Traumo, Vol. 10, Suppl. 1. 1996
Journal of Orthopaedic Trauma
Vol. 10, Suppl. 1, pp. 157-158
1!;11996 Orthopaedic Trauma Association
INDEX
Articular fracture (seespecific bones) Hip (30-D), 143 Wedgefracture (32-8)

Knee (40-D) (seealso, Patello-femoralor Distal Segment,41-45
Calcaneus (73), 109-113,150 Tibio-fibular, proximal), 144-146 Complete articular fracture (33-C)
Articular fracture (73-C), 109-113 Lisfranc (80-D), 150 Extra-articular fracture (33-A)
Dislocation, Talo-calcaneal(72-D), Metacarpal (25-D), 140-141 Partial articular fracture (33-8)
109-113 Metacarpal-carpal (25-Dl), 140 Proximal Segment(31),31-35,147-148
Extra-articular fracture (73-A), 150 Metacarpal-phalangeal(25-D2), 141 Dislocations, Patello-femoral (45-D),
Isolated body fracture (73-8), 109-113 Metatarsal, phalangeal(81-D), 150 147-148
Metatarsal-tarsal,Lisfranc (80-D), 150 Head fractures (31-C), 31-35
Carpus (24), 85-88, 140 Patello-femoral (45-D), 147-148 Neck fractures (31-8), 31-35
Carpal fractures (24-8), 85-88 Phalangeal(see also: metacarpal,or Trochanteric area fractures (31-A),
Common carpal fracture dislocation (24- metatarsal)(26-D and 81-D), 142 31-35
A), 85-88 Syndesmoticrupture (70-D), 149
Dislocations (24-D), 140 Tarsal, mid (choparts) (72-D), 149 Humerus (1), 1-15,138
Scaphoid fractures (isolated) (24-C), Talo-calcaneal(72-D), 149 Diaphyseal Segment(12),6-10
85-88 Tibio-fibular, proximal (46-D), 147 Complex fracture (12-C)
Tibio-fibular, distal (70-D), 149 Simple fracture (12-A)
Clavicle (04, 05, 06, 07), 76-80, 137 Tibio-talar (ankle) (71-D), 149 Wedgefracture (12-8)
Diaphysis (06) 77-78 Distal Segment(13), 11-15
Complex fracture (06-C) Distal (see specific bones) Complete articular fracture (13-C)
Simple fracture (06-A) Extra-articular fracture (13-A)
Wedge fracture (06-8) Distraction injnries (see specific bones) Partial articular fracture (13-8)
Lateral End (07), 79-80 Proximal Segment(11), 1-5, 138
Extra-articular, metaphysis (07-A) Epiphysis (seespecific bones) Articular (11-C), 1-5
Intra-articular fracture (07-8) Dislocation, Glenohumeral (10-D),
Medial End (05),76, 137 Extra-articular fracture (see specific 138
Metaphysis fractures (05-A), 76 bones) Extra-articular, bifocal fracture
Dislocation (04-D), 137 (11-8), 1-5
Acromioclavicular (04-D2) Fibula (4) (see also Tibia), 46--65, Extra-articular, unifocal fracture
Sternoclavicular(04-Dl) 147-149 (11-A),1-5
Diaphyseal Segment(42),51-55
Complex fractures (see specific boues) Complex fracture (42-C) Metacarpals (25), 89-93,140-141
Simple fracture (42-A) Metacarpal base (25-3),89-93
Compression injuries (seespecific bones) Wedge fracture (42-8) Metacarpal diaphysis (25--2),
Distal Segment(43),56-60 89-93
Cuboid (76), 123-126 Complex fracture (43-C), 56-60 Metacarpal head (25--1),89-93
Articular fracture (both joints) (76-C) Dislocation, Tibio-fibular, distal Dislocations (25-D), 140-141
Extra-articular fracture (no joint) (76-A) (70-D), 149 Metacarpal-carpal (25-DI), 140
Partial articular fracture (talo-navicular Simple fracture (43-A), 56---60 Metacarpal-phalangeal (25-D2),
joint) (76-8) Wedgefracture (43-8),56-60 141
Malleolar Segment(44),61-65
Joints (see Dislocations)
Cuneiform (75),119-122 Infrasyndesmotic lesion (44-A)
Articular fracture (both joints) (75-C) Suprasyndesmoticlesion (44-C) Metatarsals (81), 127-131,149-150
Extra-articular fracture (no joint) (75-A) Transsyndesmoticfibula fracture Metatarsal diaphysis (81--2)
Partial articular fracture (one joint) (44-8) Metatarsal distal (81--1)
(75-8) Proximal Segment(41),46-50,147-148 Metatarsal proximal (81--3)
Complete articular fracture (41-C), Dislocations, 149-150
Diaphysis (see specific bones) 46-50 Mid-tarsal (77-D), 149
Dislocation, tibio-fibular, proximal Metatarsal-phalangeal(81-D), 150
Dislocations (D) (see also specific bones (46-D),147-148 Tarsal-metatarsal,Lisfranc (80-D),
involved), 137-150 Extra-articular fracture (41-A), 46-50 150
Carpus (24-D), 140 Partial articular fracture (41-8),46-50
Metaphysis (see specific bones)
Clavicular (04-D), 137
Acromioclavicular (04-D2) Femur (3), 31-45,147-148 Navicular (74), 114-118
Sternoclavicular (04-Dl) Diaphyseal Segment, 36-40 Articular fracture (both joints) (74-C)
Elbow (20-D), 139 Complex fracture (32-C) Extra-articular fracture (no joint)
Glenohumeral (lO-D), 138 Simple fracture (32-A) (74-A)
157
158 SUBJECTINDEX
Partial articular fracture (talo-navicular Radius (2) (see also, Ulna), 16-30,139 Talo-calcaneal(72-D)
joint) (74-8) Diaphyseal Segment(22), 21-25
Complex fracture (22-C) Tibia (4) (see also: Fibula), 46-65,
Patella (45), 99-103,144-148 Simple fracture (22-A) 147-149
Complete articular fracture (disrupted Wedgefracture (22-8) Diaphyseal Segment(42), 51-55
extensor mechanism) (45-C), Distal Segment(23), 26-30 Complex fracture (42-C)
99-103 Complete articular fracture (23-C) Simple fracture (42-A)
Dislocation, Knee (40-D), 144-146 Extra-articular fracture (23-A) Wedge fracture (42-8)
Dislocation, Patello-femoral (45-D), Partial articular fracture (23-8) Distal Segment(43), 56--{;0
147-148 Proximal Segment(21), 16-20, 139 Complex fracture (43-C) 56--{;0
Extra-articular fracture (45-A), 99-103 Articular, fracture involving surfaceof Dislocation, Tibio-fibular, distal
Partial articular fracture (intact extensor only one bone (21-8), 16-20 (70-D), 149
mechanism) (45-8),99-103 Articular, fracture involving surface of Simple fracture (43-A), 56--{;0
both bones (21-C), 16-20 Wedge fracture (43-8),56--{;0
Pelvis (6), 66-75,143 Dislocation, Elbow (20-D), 139 Malleolar Segment(44),61-65
Acetabulum (62),71-75, 143 Extra-articular fracture (21-A), 16-20 Infrasyndesmotic lesion (44-A)
Complete articular fracture, both Suprasyndesmoticlesion (44-C)
columns (62-C), 71-75 Scapula (09), 81 -84 Transsyndesmoticfibula fracture
Partial articular fracture, one column Articular gleno id fracture (09-B) (44-8)
(62-A),71-75 Extra-articular fracture (09-A) Proximal Segment(41), 46-50, 147-148
Partial articular fracture, transverse Complete articular fracture (41-C),
(62-B),71-75 Simple fractures (see specific bones) 46-50
Dislocation, Hip (30-D), 143 Dislocation, tibio-fibular, proximal
Pelvic Ring (61),66-70 Spine (5), 151-153 (46-D), 147-148
Complete disruption of posterior arch Cervical (51) Extra-articular fracture (41-A), 46-50
(61-C) Compression injuries (51-A) Partial articular fracture (41-8),46-50
Incomplete disruption of posterior Distraction injuries (51-B)
arch (61-B) Multidirectional injuries ( 51-C) mna (2) (see also, Radius), 16-30,139
Lesion sparing posterior arch (61-A) Lumbar (53) Diaphyseal Segment(22),21-25
Compression injuries (53-A) Complex fracture (22-C)
Phalanx (26 and 82), 94-98, 132-136, 142 Distraction injuries (53-B) Simple fracture (22-A)
Phalanx (26),94-98, 142 Multidirectional injuries (53-C) Wedgefracture (22-8)
Articular and diaphysealfractures Thoracic (52) Distal Segment(23),26-30
(26-B), 94-98 Compression injuries (52-A) Complete articular fracture (23-C)
Complete articular fracture (26-C), Distraction injuries (52-B) Extra-articular fracture (23-A)
94-98 Multidirectional injuries (52-C) Partial articular fracture (23-B)
Dislocations, Phalangeal(26-D), 142 Proximal Segment(21), 16-20, 139
Extra-articular fracture (26-A), 94-98 Talus (72), 104-108,149 Articular, fracture involving surface of
Phalanx (82), 132-136, 142 Articular fracture (72-C), 104-108 only one bone (21-B), 16-20
Diaphysis (82--2), 132-136 Extra-articular fracture (72-A), Articular, fracture involving surface of
Distal (82-3), 132-136 104-108 both bones (21-C), 16-20
Proximal (82--1), 132-136 Partial articular fracture (72-8), Dislocation, Elbow (20-D), 139
Dislocations, Phalangeal(81-D), 142 104-108 Extra-articular fracture (21-A), 16-20
Dislocation, 149
Proximal (see specific bones) Tibio-talar (71-D) Wedge Fractures (see specific bones)
J OrthOD Trauma. Vol. 10. SuDD1. 1996

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Journal ofOrthopaedjc Trauma

Vol. 10, Suppl. I, pp. 1-155

Fracture and Dislocation Compendium

Orthopaedic Trauma Association

BONE: Location: Types:

B. Extra-articular, bifocal frac-

C.Articular fractures (11-C)

2. Impacted metaphysis (11-A2)

These fractures represent three part

Subgroups and Qualifications:

2. Greater tuberosity, displaced

2. Medial plus lesser tuberosity

3. Anatomical neck (11-Cl.3)

J Orthap 1rauma, Val. 10, Suppl. 1, 1996

Humerus, proximal, extra-articu- Humerus, proximal, extra-articular Humerus,proximal, articular frac-

2. Cephalotubercular with varus

3. Transcephalic (double profile

Humerus,proximal, extra-articular Humerus,proximal, extra-articular Humerus,proximal, articular frac-

2. Simple with translation (11-A3.2)

JOrthaD Trauma. Val. ]0. SuDDI. ]. ]996

BONE: Location: Types:

B. Wedge fracture (12-B)

c. Complex fracture (12-C)

J Orthap Trauma, Val. 10, Suppl. 1, 1996

2. Oblique (? 300) (12-A2) 2. Bending wedge (12-82)

3. Transverse «300) (12-A3)

Subgroups and Qualifications:

2. Middle zone (12-Al.2)

2. Middle zone (12-Bl.2)

2. With three intermediate frag-

3. Distal zone (12-AI.3)

3. Distal zone (12-Bl.3) 3. With more than three inter-

J Orthop Trauma, Val. 10, Suppl. 1, 1996

Humerus diaphyseal, simple, Humerus diaphyseal, wedge, bend- Humerusdiaphyseal,complex seg-

2. Middle zone (12-A2.2)

2. With one intermediate seg-

3. Distal zone (12-A2.3)

3. Distal zone (12-B2.3)

3. With two intermediate seg-

J Orthap Trauma, Val. 10, SuppL I, 1996

2. Middle zone (12-A3.2)

2. With limited shattering «4cm)

3. Distal zone (12-A3.3)

3. Distal zone (12-B3.3)

3. With extensive shattering

BONE: Location: Types:

B. Partial articular fracture (13-B)

C. Complete articular fractures

J Orthop Trauma, Vol. 10, Suppl. 1, 1996

2. Medial sagittal (13-B2)

Subgroups and Qualifications:

2. Medial epicondyle, non-incar-

3.T-shaped epiphyseal (13-Cl.3)

J Orthap Trauma, Val. 10, Suppl. I, 1996

2. Oblique downwards and out-

2. With a fragmented wedge

2. Metaphyseal wedge (13-C3.2)

3. Capitellum and trochlea

JOrthap Trauma, Val. 10, Suppl. 1,1996

BONE: Location: Types :

B. Articular fracture involving ar-

c. Articular fracture involving

J Orthap Trauma, Val. 10, Suppl. 1, 1996