Classification of Fractures

Why Classify?
• As a treatment guide

• To assist with
prognosis

• To speak a common
language with other
surgeons
History of Fracture Classification
• 18th & 19th century
– History based on
clinical appearance
of limb alone

Colles Fracture Dinner Fork Deformity

 Types of Fracture Classification

• Clinical
• Radiological
• Descriptive (Special) Classification
• AO
Clinical Classification
– Trauma
• High Energy

– Stress

– Pathological
• Low energy
• Metastatic
lesions
• Osteoporosis
Clinical Classification
– Open/closed

– Complicated
Radiological Classification
– X-ray
• Transverse
• Oblique
• Spiral
• Butterfly
• Segmental
• Communited
• Impacted
• Avulsion
– CT Scan
• Calcaneal Fractures
 Special Classification Systems
– Garden:
• Femoral neck
– Schatzker:
• Tibial plateau
– Neer:
• Proximal Humerus
– Lauge-Hansen:
• Ankle
 AO Classification
• There has been a need for an organized,
systematic fracture classification
• Goal:
– A comprehensive classification adaptable to
the entire skeletal system!
• Answer:
– AO Comprehensive Classification of Long Bone
Fractures
To Classify a Fracture

• Which bone?
• Where in the bone is
the fracture?
• Which type?
• Which group?
• Which subgroup?
AO Classification
Which bone?
Where in the bone is the fracture?
Which type?
Which group?
Which subgroup?
1 2 3 4

— .
Bone Segment Type Group Subgroup
A

B
Types A, B, C:
A = simple pattern
B = multifragmentary, wedge
C = multifragmentary, complex
C
12 22 32 42
Classification of Soft tissue injuries
• Classification Systems
– Open – Gustilo and Anderson
– AO soft tissue classification
Gustilo and Anderson Classification
Type Wound Contamination Soft tissue
Bone________
• I < 1cm Clean Minimal Simple

• II >1cm Moderate Moderate Moderately

comminuted
• IIIA >10 cm High Severe crush Comm but
cover
possible
B > 10 cm High Loss of cover Poor
coverage req
recon surg
C > 10 cm High Vessel & nerve Poor cover
req recon surg
 Gustilo and Anderson I

• Inside-out injury
• Clean wound
• Minimal soft tissue
damage
• No significant
periosteal stripping
• Transverse / short
oblique fracture
 Gustilo and Anderson II
• Moderate soft tissue
damage
• Outside-in mechanism
• Higher energy injury
• Some necrotic muscle,
some periosteal
stripping
 Gustilo and Anderson III

• High energy
• Outside-in injury
• Extensive muscle
devitalization
• Bone coverage with
existing soft tissue not
problematic
 Type IIIB Open Fractures
• High energy
• Outside in injury
• Extensive muscle
devitalization
• Requires a local flap
or free flap for bone
coverage and soft
tissue closure
• Periosteal stripping
 Type IIIC Open Fractures
• High energy
• Increased risk of
amputation and
infection
• Major vascular injury
requiring repair
Thank You!