Dr.

Abdirahman Adan
 Description of Fructure

A disruption in the continuity of the

structure of bone.
Traumatic injuries account for the
majority of fractures.
Can be stable or unstable
Classification of fractures according
1. Integrity of Skin/Soft Tissue

 Closed: skin/soft tissue over and near fracture is

intact

 Open: skin/soft tissue over and near fracture is

lacerated or abraded, fracture exposed to outside
environment
 Signs: continuous bleeding from puncture site or
fat droplets in blood are suggestive of an open
fracture
2. Location
Location is the anatomic location of the fracture usually
described by giving the bone involved and location on the
bone
Examples are: distal radial shaft, proximal 1/3 humeral
shaft, intra-articular distal tibial
location
Epiphyseal: end of bone, forming part of the adjacent
joint
Metaphyseal: the flared portion of the bone at the
ends of the shaft
Diaphyseal: the shaft of a long bone (proximal,
middle, distal)
Physis: growth plate
location
3. Fructure patern or Type
Type is the overall
fracture pattern
Examples are:
Simple
Spiral
Segmental
Comminuted
Transverse
Oblique
Green stick
Butterfly
 Orientations
Transverse: fracture line perpendicular to long axis of bone;
direct high energy force
Oblique: angular fracture line; angular or rotational force
Butterfly: fracture site fragment which looks like a butterfly
Segmental: a separate segment of bone bordered by fracture
lines; high energy
Spiral: complex, multi-planar fracture line; rotational force,
low energy
Comminuted/multi-fragmentary: more than 2 fracture
fragments
 Cont…
Intra-articular: fracture line crosses articular
cartilage and enters joint
Avulsion: tendon or ligament tears/pulls fragment
off bone; often in children, high energy
Compression/impacted: impaction of bone, e.g.
vertebrae, proximal tibia
Torus: a buckle fracture of one cortex, often in
children
Green-stick: an incomplete fracture of one cortex,
often in children
Pathologic: fracture through bone weakened by
disease/tumour
 Displacement
Displacement is the amount the pieces of a
fracture have moved from their normal
location
Can be displaced or non-displaced
Subdivided into 3 sub-categories:
translation, angulation, and shortening
Displacement - Translation
Translation is
sideways motion of
the fracture - usually
described as a
percentage of
movement when
compared to the
diameter of the bone.
Displacement - Angulation
Angulation is the
amount of bend at a
fracture described in
degrees. Described
with respect to the
apex of the angle or
with respect to
direction of distal
fragment.
Displacement - Shortening
Shortening is the
amount a fracture is
collapsed expressed
in centimeters.
Anatomic description?
Anatomic description
Simple, transverse,
non-communited
midshaft radial and
ulnar fracture with 30
degrees apex radial
angulation.
Anatomic description??
Anatomic description
Simple, transverse,
non-communited
distal radial and
ulnar fracture with
100% radial
translation, 45
degrees apex ulnar
angulation and 2 cm
of shortening.
Why classify fractures?
Classification or description of fractures is only used
when the classification or description is useful in
providing treatment or outcomes
Types of classifications
Anatomic description
AO classification
Salter-Harris classification
Gustillo open fracture classification
Fracture specific classifications
AO Classification
AO Classification
1st number = long bone
2nd number = bone segment
Letter = fracture type (A,B,C)
Then 3rd & 4th numbers classify fracture group
& subgroup
Salter-Harris Classification
Only used for pediatric fractures that involve the
growth plate (physis)
Five types (I-V)
Salter-Harris type I fracture
Type I fracture is
when there is a
fracture across the
physis with no
metaphysial or
epiphysial injury
Salter-Harris type II fracture
Type II fracture is
when there is a
fracture across the
physis which extends
into the metaphysis
Salter-Harris type III fracture
Type III fracture is
when there is a
fracture across the
physis which extends
into the epiphysis
Salter-Harris type IV fracture
Type IV fracture is
when there is a
fracture through
metaphysis, physis,
and epiphysis
Salter-Harris type V fracture
Type V fracture is
when there is a crush
injury to the physis
Gustillo classification
The Gustillo classification is used to classify open
fracture - ones in which the skin has been
disrupted
Three grades that try to quantify the amount of
soft tissue damage associated with the fracture
Open fractures - grade 1
wound less than 1 cm w/
minimal soft tissue injury
wound bed is clean
bone injury is simple w/ minimal
comminution
w/ IM nailing, average time to
union is 21-28 weeks
Open fractures - grade 2
wound is greater than 1 cm
w/ moderate soft tissue
injury
wound bed is moderately
contaminated
fracture contains moderate
comminution
w/ IM nailing, average time
to union is 26-28 weeks
Open fractures - grade 3A
wound greater than 10 cm w/
crushed tissue and contamination
soft tissue coverage of bone is
usually possible
w/ IM nailing, average time to
union is 30-35 weeks
Open fractures - grade 3B
wound greater than 10 cm w/
crushed tissue and contamination
soft tissue is inadequate and
requires regional or free flap
w/ IM nailing, average time to
union is 30-35 weeks
Open fractures - grade 3C
is fracture in which there
is a major vascular injury
requiring repair for limb
salvage.
Increased risk of
amputation and infection