CLASSIFICATION OF SPECIAL #S Flashcards
LIST THE CLASSIFICATIONS OF SPECIAL FRACTURES
Oestern and Tscherne grading of closed #s
Gustilo - Anderson classification of open #s
Salter- Harris classification of #s involving epiphyseal plate
Classifications of shaft of femur
Gartilands’ classification of supracondylar #
Garden classification of neck of femur #s
Boyd- griffin classification of intertrochanteric #s
Weber classification of Ankle #s
OUTLINE THE OESTERN AND TSCHERNE CLASSIFICATION OF CLOSED FRACTURES
A. Classification for closed fractures
Tscherne (Oestern and Tscherne, 1984) devised classification of closed injuries:
Grade 0 – a simple fracture with little or no soft tissue injury.
Grade 1 – a fracture with superficial abrasion or bruising of the skin and subcutaneous tissue.
Grade 2 – a more severe fracture with deep soft tissue contusion and swelling.
Grade 3 – a severe injury with marked soft-tissue damage and a threatened compartment syndrome
OUTLINE THE CLASSIFICATION OF #S OF THE EPIPHYSEAL PLATE
OUTLINE THE GUSTILO-ANDERSON CLASSIFICATION OF OPEN FRACTURES
Gustilo - Anderson classification of open #s:
Type I- Clean wound < 1 cm in diameter, simple # pattern, no skin crushing. Clean puncture through which a bone spike has protruded with little soft tissue damage with no crushing and the fracture is not comminuted (i.e. a low-energy fracture).
Type II- A laceration > 1 cm but without significant soft tissue crushing, including no flaps, degloving or contusion. # Pattern may be more complex.
Type III-An open segmental # or a single # with extensive soft tissue injury. Also included are injuries older than 8 hours. It subdivided into 3 types:
IIIA Adequate soft tissue coverage of the # despite high energy trauma or extensive laceration or skin flaps. No periosteal striping
IIIB Inadequate soft tissue coverage with periosteal stripping. Soft tissue reconstruction is necessary. With periosteal striping.
IIIC Any open # that is associated with an arterial injury that requires repair. Neurovascular damage
OUTLINE THE CLASSIFICATION OF #S OF THE SHAFT OF THE FEMUR
Classifications of shaft of femur:
Nature: Closed or open
Geometry: Transverse, oblique etc.
-Location: Proximal, Middle or Distal
OUTLINE THE CLASSIFICATION OF SUPRACONDYLAR #S
Gartilands’ classification of supracondylar #:
Type 1 - Undisplaced #
Type 2 - Displaced # with intact posterior cortex
Type 3 - Complete displacement #
OUTLINE THE CLASSIFICATION OF #S OF THE NECK OF THE FEMUR
Garden classification of neck of femur #s:
Type1 - Incomplete or impacted #
-Media trabecular intact
-Vascularity preserved
Type2 - Complete # without displacement
-Trabecular aligned
-Vascularity preserved
Type3 - Complete #
-Partial displacement of < 50% diameter
-Trabeculae unaligned
-Blood supply damaged but fragment still connected by posterior retinacular attachment
Type 4 - Complete #
-Complete displacement
-No trabecular alignment
-Vascular damage (Ischemic)
OUTLINE THE CLASSIFICATION OF INTERTROCHANTERIC #S
Boyd- griffin classification of intertrochanteric #s:
* Type1 - Undisplaced #
* Type2 - Partially displaced #
* Type3 - Reverse #
* Type4 - Displaced intertrochanteric # with subtrochanteric extension
OUTLINE THE CLASSIFICATION OF ANKLE #S
Weber classification of Ankle #s:
Type A - Below the syndesmosis
Type B - At the syndesmosis
Type C - Above the syndesmosis
WHAT IS CONTIUOUS TRACTION?
Traction is applied to the limb distal to the fracture, so as to exert a continuous pull in the long axis of the bone, with a counterforce in the opposite direction (to prevent the pt from being dragged along the bed).
Useful for oblique or spiral shaft fractures and those easily displaced by muscle contraction.
It cannot hold a fracture still; but can pull a long bone straight and hold it out to length
WHAT ARE THE TYPES OF TRACTIONS FOR #S?
Traction by gravity
Skin traction
Skeletal traction
DESCRIBE TRACTION BY GRAVITY
Traction by gravity – applies only to upper limb injuries.
With a wrist sling the weight of arm provides continuous traction to the humerus.
For comfort and stability, a U-slab of plaster may be bandaged on or, better, a removable plastic sleeve from the axilla to just above the elbow is held on with Velcro e.g. in transverse fractures
DESCRIBE SKIN TRACTION
Skin traction – sustain a pull of no more than 4 or 5 kg.
Holland strapping or oneway-stretch Elastoplast is stuck to the shaved skin and held on with a bandage.
Gamgee tissue, and cords or tapes are used to protected malleoli
DESCRIBE SKELETAL TRACTION
Skeletal traction – A stiff wire or pin is inserted – usually behind the tibial tubercle for hip, thigh and knee injuries, or through the calcaneum for tibial fractures – and cords tied to them for applying traction
DESCRIBE THE WAYS IN WHICH #S ARE REDUCED AND HELD VIA SKIN/SKELETAL TRACTION
Fracture is reduced and held in one of 3 ways by skin or skeletal traction
a) Fixed traction - pull is exerted against a fixed point.
Usually traction cords are tied to the distal end of a Thomas’ splint and pull the leg down until the proximal, padded ring of the splint abuts firmly against the pelvis.
b) Balanced traction- traction cords are guided over pulleys at the foot of the bed and loaded with weights; counter-traction is provided by the weight of the body when the foot of the bed is raised.
c) Combined traction- a combination of the two.
If a Thomas’ splint is used, tapes are tied to the end of the splint and the entire splint is then suspended, as in balanced traction
