Classification of fracture

Classification of the extent and type of fracture and its

associated soft tissue injuries allows determination of
the best treatment.
Analysis of the fracture pattern reveals :
amount of energy imparted to the extremity
the stability of the fracture after reduction
alerts the surgeon to higher-risk patterns of injury
to monitor results and to compare treatment results
with those of other surgeons and investigators
provides a basis for the evaluation of new treatment
methods

 The Orthopaedic Trauma Association

(OTA) classification correlates the
coding of the fracture with the
expanded ICD-9 codes for diagnosis
and treatment
The AO classification by Muller et al. is
based on the morphological
characteristics and the location of the
fracture.
Taylor and Martin proposed a
classification of metaphyseal fractures
in which the main fracture is

Taylor and Martin divided into three

subtypes :
0. Extraarticular
1. Less than 2 mm of displacement
2. More than 2 mm of displacement
. With progression from type S to type
D, treatment shifts toward external
fixation and away from open
reduction
. Conversely, with progression from
subgroup 0 to subgroup 2, open

Classification of Soft Tissue

Injuries
Gustilo and Anderson in 1976
described their treatment of 1025
open fractures with application of a
grading system that offered
prognostic information about the
outcome of infected fractures.
In 1984 this system was modified and
their results updated.

The modified classification ( by Gustilo

and Anderson ) is based on :
the size of the wound
periosteal soft tissue damage
periosteal stripping
vascular injury

Gustilo and Anderson

Classification

Type I : have a clean wound less than 1

cm long
Type II : wound more than 1 cm long
without extensive soft tissue damage,
skin flap or avulsi
Type III A : have extensive soft tissue
lacerations or flaps but maintain
adequate soft tissue coverage of bone, or
they result from high-energy trauma
regardless of the size of the wound. This
group includes segmental or severely

Gustilo and Anderson

Classification
Type III B : have extensive soft tissue loss
with periosteal stripping and bony
exposure. They usually are massively
contaminated
Type III C : open fractures with an arterial
injury that requires repair regardless of
the size of the soft tissue wound

 Other classifications include that of

Tscherne and Gotzen. Closed fractures are
divided into grades 0 through 3 and open
fractures are divided into grades 1
through 4. This system includes soft tissue
damage and compartment syndrome
The AO-ASIF group added to their
extensive fracture classification a soft
tissue classification scheme that closely
follows that of Tscherne and Gotzen
includes both closed and open injuries,
muscle-tendon injury and neurovascular
injury

A number of other trauma scoring systems

have been proposed, including :
Trauma Score (TS),
Revised Trauma Score (RTS),
Injury severity Score (ISS),
Modified Abbreviated Injury Severity Scale
(MISS),
Pediatric Trauma Score (PTS),
Nerve injury, Ischemia, Soft tissue Injury,
Skeletal Injury, Shock and Age of Patient
Score
(NISSSA)
Hanover Fracture Scale-97 (HFS-97)