Classification Flashcards
1
Q
Mayfield classification of progressive perilunate dislocation
A
- Stage I represents scapholunate failure
- stage II, capitolunate failure
- stage III, triquetrolunate failure
- stage IV, dorsal radiocarpal ligament failure, allowing lunate dislocation.
2
Q
Johnson and Strom in 1989 PTT insufficiency
A
- Stage I disease is characterized by swelling, pain, inflammation, and often effusion within the posterior tibial tendon sheath.
- Stage II disease is characterized by the loss of function of the posterior tibial tendon and inability to perform a single-leg toe raise. There is attempted compensation by use of the anterior tibial muscle and tendon unit as an accessory inverter of the hindfoot.
- stage IIA, less than 30% of the talar head is uncovered on standing anteroposterior radiographs and abduction deformity is minimal
- stage IIB, more than 30% of the talar head is uncovered and the abduction deformity is severe.
- stage III disease, the function of the posterior tibial tendon is lost, and a semirigid or rigid hindfoot deformity with valgus abduction occurs and degenerative changes may be apparent on radiographs
- Stage IV disease was described by Myerson et al. and involves valgus positioning and incongruence of the ankle joint in addition to stage III findings.
3
Q
Wagner Classification for Foot Ulcers
A
- 0 Skin at risk
- I Superficial ulcer
- II Exposed tendon and deep structures
- III Deep ulcers with abscess or osteomyelitis
- IV Partial gangrene
- V More extensive gangrene
4
Q
- Brodsky Depth-Ischemia Classification for Foot Ulcers
- Proprioceptive dysfunction
- Neurotraumatic theory
- Neurovascular theory inflammatory theory
A
DEPTH Classification Description
- 0 At risk foot, no ulceration
- 1 Superficial ulceration, no infection
- 2 Deep ulceration, tendons or joint exposed
- 3 Extensive ulceration or abscess
- ISCHEMIA
- A Not ischemic
- B Ischemia without gangrene
- C Partial forefoot gangrene
- D Complete gangrene
- ISCHEMIA
5
Q
Eichenholtz Classification of Charcot Arthropathy in the Diabetic Foot
A
STAGE RADIOGRAPHIC SIGNS CLINICAL SIGNS
- 0 No osteoporosis noted Unilateral oedema, erythema; warm, intact skin
- 1 Fragmentation Osseous destruction, joint subluxation/dislocation Similar to stage 0
- 2 Coalescence Absorption of bone debris with the coalescence of small fracture fragments Decreased erythema, warmth, oedema
- 3 Consolidation and remodelling fracture fragments No oedema, warmth, or erythema
6
Q
Jersey Finger Refers to an avulsion injury of FDP from insertion at base of distal phalanx
A
Leddy and Packer classification
- Type I FDP tendon retracted to palm. Leads to disruption of the vascular supply Prompt surgical treatment within 7 to 10 days
- Type II FDP retracts to level of PIP joint Attempt to repair within several weeks for opitmal outcome
- Type III Large avulsion fracture limits retraction to the level of the DIP joint Attempt to repair within several weeks for opitmal outcome
- Type IV Osseous fragment and simultaneous avulsion of the tendon from the fracture fragment (“Double avulsion” with subsequent retraction of the tendon usually into palm) If tendon separated from fracture fragment, first fix fracture via ORIF then reattach tendon as for Type I/II injuries
- Type V Ruptured tendon with bone avulsion with bony comminution of the remaining distal phalanx (Va, extraarticular; Vb, intra-articular)
7
Q
Kienbock’s Disease Avascular necrosis of the lunate leading to abnormal carpal motion
A
- Stage I No visible changes on xray, changes seen on MRI Immobilization and NSAIDS
- Stage II Sclerosis of lunate Joint
- leveling procedure (ulnar negative patients)
- Radial wedge osteotomy or STT fusion (ulnar neutral patients)
- Distal radius core decompression Revascularization procedures
- Stage IIIA Lunate collapse,
- no scaphoid rotation Same as Stage II above
- Stage IIIB Lunate collapse, fixed scaphoid rotation
- Proximal row carpectomy, STT fusion, or SC fusion
- Stage IV Degenerated adjacent intercarpal joints Wrist fusion, proximal row carpectomy, or limited intercarpal fusion
8
Q
Rheumatoid thumb deformities
A
- Type I, the most common, is a boutonniere deformity
- Type II, which is rare, includes metacarpophalangeal joint flexion, interphalangeal joint hyperextension, and trapeziometacarpal joint subluxation or dislocation
- type III, the second most common, is a swan-neck deformity
- type IV, which is unusual, results from ulnar collateral ligament laxity and includes the abduction of the proximal phalanx with metacarpal adduction
9
Q
Eaton and Littler Classification of Basilar Thumb Arthritis
A
- Stage I slight joint space widening (pre-arthritis)
- Stage II slight narrowing of CMC joint with sclerosis, osteophytes <2mm
- Stage III marked narrowing of CMC joint with osteophytes, osteophytes >2mm
- Stage IV pantrapezial arthritis (STT involved)
10
Q
Mallet Finger - A finger deformity caused by disruption of the terminal extensor tendon distal to DIP joint - the disruption may be bony or tendinous
A
Doyle’s Classification
- Type I Closed injury with or without small dorsal avulusion fracture
- Type II Open injury (laceration)
- Type III Open injury (deep soft tissue abrasion involving loss skin and tendon substance)
- Type IV Mallet fracture
- A = distal phalanx physeal injury (pediatrics)
- B = fracture fragment involving 20% to 50% of articular surface (adult)
- C = fracture fragment >50% of articular surface (adult)
11
Q
Wassel Classification of Preaxial Polydactyly
A
- Type I Bifid distal phalanx
- Type II Duplicated distal phalanx
- Type III Bifid proximal phalanx
- Type IV Duplicated proximal phalanx (most common)
- Type V Bifid metacarpal
- Type VI Duplicated metacarpal
- Type VII Triphalangia
12
Q
SNAC A condition characterized by advanced collapse and progressive arthritis of the wrist that results from a chronic scaphoid nonunion
A
- Stage I • Arthrosis localized to the radial side of the scaphoid and radial styloid
- Stage II •Scaphocapitate arthrosis in addition to Stage 1
- Stage III • Periscaphoid arthrosis (proximal lunate and capitate may be maintained)
13
Q
Cervical Myelopathy is a common degenerative condition caused by compression on the spinal cord that is characterized by clumsiness in hands and gait imbalance.
A
Nurick Classification Based on gait and ambulatory function
- Grade 0 Root symptoms only or normal
- Grade 1 Signs of cord compression; normal gait
- Grade 2 Gait difficulties but fully employed
- Grade 3 Gait difficulties prevent employment, walks unassisted
- Grade 4 Unable to walk without assistance
- Grade 5 Wheelchair or bedbound
14
Q
Cervical Myelopathy is a common degenerative condition caused by compression on the spinal cord that is characterized by clumsiness in hands and gait imbalance.
A
Ranawat Classification
- Class I Pain, no neurologic deficit
- Class II Subjective weakness, hyperreflexia, dyssthesias
- Class IIIA Objective weakness, long tract signs, ambulatory
- Class IIIB Objective weakness, long tract signs, non-ambulatory
15
Q
Spinal cord injury ASIA
A
ASIA Classification
- Step 1 Determine if patient is in spinal shock check bulbocavernosus reflex
- Step 2 Determine neurologic level of injury
- lowest segment with intact sensation and antigravity (3 or more) muscle function
- strength in regions where there is no myotome to test, the motor level is presumed to be the same as the sensory level.
- Step 3 Determine whether the injury is COMPLETE or INCOMPLETE
- COMPLETE defined as
- (ASIA A) no voluntary anal contraction (sacral sparing) AND 0/5 distal motor AND 0/2 distal sensory scores (no perianal sensation) AND bulbocavernosus reflex present (patient not in spinal shock)
- INCOMPLETE defined as voluntary anal contraction (sacral sparing) sacral sparing critical to determine complete vs. incomplete OR palpable or visible muscle contraction below injury level OR perianal sensation present
- COMPLETE defined as
16
Q
lumbar spinal stenosis is a degenerative condition characterized by narrowing of the lumbar spinal canal due to bony structures soft tissue structures
A
Anatomic classification
- central stenosis - caused by ligamentum hypertrophy directly under the lamina
- lateral recess stenosis (subarticular recess - caused by facet joint arthropathy and osteophyte formation
- foraminal stenosis - occurs between the medial and lateral border of the pedicle caused by a substantial loss of disk height, foraminal disk protrusions or osteophytes, or angulation in the setting of degenerative scoliosis
- extraforaminal stenosis - located lateral to the lateral edge of the pedicle
17
Q
Degenerative Spondylolisthesis
- A condition characterized by lumbar spondylolisthesis without a defect in the pars
A
Myerding Classification
- Grade I < 25%
- Grade II 25 to 50%
- Grade III 50 to 75% (Grade III and greater are rare in degenerative spondylolithesis)
- Grade IV 75 to 100%
- Grade V Spondyloptosis (all the way off)
18
Q
thoracolumbar burst fractures are a common traumatic vertebral fracture that primarily involves a compression force through the anterior and middle column of the vertebrae leading to retropulsion of bone into the spinal canal
A
Thoracolumbar Injury Classification and Severity Score
- injury morphology
- neurologic status
- posterior ligamentous complex integrity
19
Q
odontoid fractures
A
Anderson and D’Alonzo Classification
- Type I Oblique avulsion fx of tip of odontoid. Due to avulsion of alar ligament. Although rare, atlantooccipital instability should be ruled out with flexion and extension films.
- Type II Fx through waist (high nonunion rate due to interruption of blood supply).
- Type III Fx extends into cancellous body of C2 and involves a variable portion of the C1-C2 joint.
20
Q
odontoid fractures
A
Grauer Classification of Type II Odontoid fractures
- Type IIA Nondisplaced/minimally displaced with no comminution. Treatment is external immobilization
- Type IIB Displaced fracture with fracture line from anterosuperior to posteroinferior. Treatment is with anterior odontoid screw (if adequate bone density).
- Type IIC Fracture from anteroinferior to posterosuperior, or with significant comminution. Treatment is with posterior stabilization.
21
Q
Incomplete Spinal Cord Injuries
- Defined as spinal cord injury with some preserved motor or sensory function below the injury level including
A
Clinical classification
- anterior cord syndrome
- Brown-Sequard syndrome
- central cord syndrome
- posterior cord syndrome
22
Q
Scheuermann’s Kyphosis
- A rigid thoracic hyperkyphosis defined by > 45 degrees
- > 45 degrees caused by anterior wedging of >5 degrees
- across three consecutive vertebrae,
- narrowed disc spaces
A
- Thoracic Scheuermann’s Kyphosis curve from T1/2 to T12/L1 with apex between T6-T8 better prognosis
- Thoracolumbar/lumbar Scheuermann’s Kyphosis curve from T4/5 to L2/3 with apex near the thoracolumbar junction associated with increased back pain more likely to be progressive and symptomatic more irregular end-plates noted on radiographs, less vertebral body wedging
