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Alexey Ortho Flashcards > Classification Systems > Flashcards

Classification Systems Flashcards

1
Q

Enneking Staging of Benign Bone Tumors

A 
1 = Latent lesion
2= Active lesion
3= Aggressive lesion
Latent = NOF, Enchondroma
Active = ABC, UBC, ChondroMyxoid Fibroma, Chondroblastoma
Aggressive = Giant cell tumor
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2
Q

Enneking Staging of Malignant Bone Tumors

A 
Ia = Low Grade, Intracompartmental, No Mets
Ib = Low Grade, Extracompartmental, No Mets
IIa = High Grade, Intracompartmental, No Mets
IIb = High Grade, Extracompartmental, No Mets
III = Mets
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3
Q

Bigliani Classification of Acromial Morphology

A

Type I = Flat
Type II = Curved
Type III = Hooked

Based on supraspinatus outlet view
Poor interobserver reliability

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4
Q

Goutallier Grading of Rotator Cuff Atrophy

A 
0 = Normal
1 = Soft fatty streaks
2 = More muscle than fat
3 = Equal muscle and fat
4 = More fat than muscle

Based on a saggital CT, no MRI

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5
Q

Seebauer Classification of Rotator Cuff Arthropathy

A

Type IA = Centered, Stable
Type IB = Centered, Medialized
Type IIA = Decentered, Stable
Type IIB = Decentered, Unstable

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6
Q

Hamada Classification of Rotator Cuff Arthropathy

A

Grade 1 = AcromioHumeral interval >= 6mm
Grade 2 = Acromiohumeral interval <= 5mm
Grade 3 = Acetabularization of the acromion
Grade 4A = GH arthrosis without acetabularization (AHI <7mm)
Grade 4B = GH arthrosis with acetabularization (AHI <= 5mm)
Grade 5 = Humeral head collapse

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7
Q

Walch Classification of Glenoid Wear

A 
Type A1 = Centered, minor erosion
Type A2 = Centered, central erosion
Type B1 = Posterior wear
Type B2 = Severe biconcave wear
Type C = Retroversion > 25 degrees (dysplastic)
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8
Q

Cruess Staging of Humerus AVN

A

Stage I = Normal XR, Changes on MRI
Stage II = Sclerosis (wedged), Osteopenia
Stage III = Crescent sign (subchondral fracture)
Stage IV = Flattening and collapse
Stage V = Glenohumeral degeneration

Stage I and II = core decompression
Stage II and IV = Resurfacing or Hemi
Stage V = Total shoulder arthroplasty

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9
Q

SLAP tear Classification

Snyder includes Types 1 to 4

A

Type I = Labral fraying, Biceps fraying, Anchor intact
Type II = Labral fraying, Detached anchor
Type III = Bucket handle labral tear, Anchor intact (biceps separated from labrum)
Type IV = Bucket handle labral tear, Anchor detached (biceps attached to labrum)

Type V = Type II + Anteroinferior labral tear (Bankart)
Type VI = Type II + Unstable flap
Type VII = Type II + MGHL injury
Type VIII = Type II + Posterior extension
Type IX = Circumferential
Type X = Type II + Posteroinferior labral tear (Reverse Bankart)

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10
Q

Neer Classification of Distal Clavicle Fractures

A

Type I = Lateral to CC ligaments (stable)

Type IIA = Medial to CC ligaments (unstable)
Type IIB = Through (Between or through both) CC ligaments (unstable)

Type III = Through ACJ (stable) (CC ligs intact)
Type IV = Physeal (stable) (CC ligs intact)
Type V = Comminuted (unstable) (CC ligs intact)

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11
Q

Ideberg Classification of Glenoid Fractures

A

Type Ia = Anterior rim
Type Ib = Posterior rim

Type II = Glenoid fossa exiting InferoLateral
Type III = Glenoid fossa exiting SuperoLateral
Type IV = Glenoid fossa exiting Medial

Type Va = II and IV (Medial and InferoLateral)
Type Vb = III and IV (Medial and SuperoLateral)
Type Vc = II, III and IV (Medial and Supero and Infero Lateral)

Type VI = Severe comminution

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12
Q

Hertel Predictors of Humeral Head Ischaemia

A

<8mm of calcar length attached to articular fragment
Disrupted medial hinge
Anatomic neck
97% PPV if above three combined

Moderate to poor predictors
Four fragments
Displacement > 10 mm
Angulation > 45 degrees
Dislocation
Head split
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13
Q

Ogawa Classification of Coracoid Fractures

A

Type I = Posterior to CC ligaments (surgery)

Type II = Anterior to CC ligaments (non-op)

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14
Q

Kuhn Classification of Acromial Fractures

A

Type Ia = avulsion fractures
Type Ib = minimally displaced
Type II = displaced, subacromial space not compromised
Type III = displaced, subacromial space compromised

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15
Q

Classification of Prosthetic Joint Infections

A

Type I = Acute (first month)
Type II = Late chronic (after first month)
Type III = Acute Haematogenous (previously well-functioning joint)
Type IV = Positive Intra-op Cultures

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16
Q

Wright and Cofield Classification of Periprosthetic Proximal Humerus Stem fractures

A

Type A - Proximal extension from tip of the stem
Type B - Distal extension from tips of the stem
Type C - Distal to the tip of the stem

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17
Q

Serveaux Classification of Scapular Notching in RTSR

A

Grade 1 = Scapular pillar
Grade 2 = Inferior screw and baseplate
Grade 3 = Beyond the inferior screw
Grade 4 = Approaches central peg

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18
Q

Leddy and Packer Classificaiton of FDP tendon avulsions

A

Type I = Retracted to palm (vinculae torn)
Type II = Retracted to PIPJ
Type III = Bony fragment - (limits retraction to DIPJ)
Type IV = Double avulsion - Bony fragment and tendon avulsed from bony fragment
Type V = Comminuted distal phalanx (and bony avulsion)

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19
Q

Doyle’s Classification of Mallet Finger injuries

A

Type I = Closed injury (can have small dorsal avulsion up to 20%)
Type II = Laceration Open injury
Type III = Abrasion Open injury (loss of skin or tendon)
Type IV = Mallet fracture
- A: Physeal (Paeds)
- B: Fracture fragment 20% - 50%
- C: Fracture fragment >50%

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20
Q

Mayfield Classification of Peri-Lunate Dislocations

A

Stage I = Schaphoid - Lunate dissociation
Stage II = Scaphoid - Lunate - Capitate dissociation
Stage II = Scaphoid - Lunate - Capitate - Triquetrum dissociation
Stage IV = Lunate dislocated from its fossa

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21
Q

Herzberg Classification of Peri-lunate Dislocations

A

Stage I = Dorsal dislocation of the capitate from the lunate
Stage IIA = Volar dislocation of the lunate from its fossa with less than 90 degrees rotation
Stage IIB = Volar dislocation of the lunate from its fossa with more than 90 degrees rotation

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22
Q

Seddon Classification of Nerve Injuries

A 
Neuropraxia = Myelin damaged
Axonotmesis = Axon damaged
Neurotmesis = Nerve damaged

Sunderland further subdivides Neurotmesis
3 = Endoneurium damaged
4 = Perineurium damaged
5 = Epineurium damaged

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23
Q

Green Classification of Trigger Finger

A

Grade 1 = Pain and tenderness
Grade 2 = Catching
Grade 3 = Locking
Grade 4 = Locked

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24
Q

Eaton and Littler Classification of Basilar Thumb Arthritis

A

Stage I = Widening
Stage II = <2 mm osteophytes
Stage III = >2mm osteophytes
Stage IV = Pantrapezial (STT involved)

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25
Q

Lichtman Classification of Lunate AVN

A

Stage I = MRI changes only (low on T1)
Stage II = Sclerosis of lunate
Stage III = Lunate collapse (A = no scaphoid rotation, B = fixed scaphoid flexion)
Stage IV = Adjacent joint arthritis

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26
Q

Lichtman Classification of Lunate AVN

A

Stage I = MRI changes only (low on T1)
Stage II = Sclerosis of lunate
Stage III = Lunate collapse (A = no scaphoid rotation, B = fixed scaphoid rotation)
Stage IV = Adjacent joint arthritis

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27
Q

Radiographic Stages of SNAC wrist

A

Stage I = Radial styloid arthritis
Stage II = Scapho-Capitate arthritis
Stage III = Peri-Scaphoid arhritis

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28
Q

Bayne and Klug Classification of Radial Clubhand

A

Type I = Distal Epiphysis deficient
Type II = Distal and Proximal Epiphyses deficient
Type III = Distal half absent (proximal half present)
Type IV = Complete absence (most common)

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29
Q

Steinberg (modified Ficat) Classification of Femoral Head AVN

A

Stage 0 = Normal hip
Stage 1 = MRI or Bone scan changes, Normal XR
Stage 2 = Cysts or sclerosis
Stage 3 = Crescent sign (subchondral collapse)
Stage 4 = Flattening
Stage 5 = Narrowing of joint space
Stage 6 = Arthritis on the acetabular side

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30
Q

Musculoskeletal Infection Society (MSIS) 2018 criteria for prosthetic joint infection

A

1 Major OR 6 Minor = Infected
0-1 Minor = Not infected

Major:

  1. Sinus tract to prosthesis
  2. Pathogen on 2 separate joint culures
Minor:
- Serum:
1 Point = ESR > 30
2 Points = CRP >10 OR D-dimer >860
- Synovial
1 Point = CRP >6.9
2 Points = PMN >80%
3 Points = Alpha defensin Positive
3 Points = WBC >3000 or Leukocyte Esterase Positive
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31
Q

Vancouver Intraoperative Femur fracture Classification

A 
A = Metaphysis
B = Diaphysis (around stem)
C = Distal to stem
Subclass for each
1 = Cortical perforation
2 = Undisplaced fracture
3 = Unstable fracture
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32
Q

Vancouver Postoperative Femur fracture Classification

A 
A = Trochanteric
B = Around stem
C = Distal to stem
B1 = Well-fixed stem
B2 = Loose stem, good bone stock
B3 = Loose stem, poor bone stock
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33
Q

AAOS Classification of Acetabular bone loss

A 
I = Segmental
II = Cavitary
III = Combined (segmental and cavitary)
IV = Pelvic discontinuity (superior acetabulum separate from inferior)
V = Arthrodesis
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34
Q

Paprosky Classification of Acetabular bone loss

A 
1 = Intact rim, minimal bone loss
2A = Superior Medial bone loss, Superior rim intact
2B = Superior Lateral bone loss (Absent superior rim)
2C = Central Medial bone loss (Absent medial wall)
3A = Severe rim and column loss
3B = Pelvic discontinuity + rim and column loss
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35
Q

AAOS Classification of Proximal Femoral bone loss

A 
I = Segmental
II = Cavitary
III = Combined
IV = Malalignment
V = Stenosis
VI = Discontinuity
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36
Q

Paprosky Classification of Femoral bone loss

A 
1 = Metaphyseal minimal loss
2 = Metaphyseal extensive loss
3A = 4cm of diaphysis intact below extensive metadiaphyseal bone loss
3B = <4cm of diaphysis intact below extensive metadiaphyseal bone loss
4 = Nonsupportive diaphysis + extensive metadiaphyseal bone loss
Treatment
1 = Normal stem
2 = Long-stem uncemented
3a = Long-stem or impaction grafting
3b and 4 = Impaction bone grafting, or Endoprosthesis
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37
Q

Kellgren and Lawrence Classification of Knee OA

A 
on XR
0 = Normal
1 = No JSN, Possible osteophytes
2 = Definite osteophytes, Possible JSN
3 = Definite JSN, Possible sclerosis, deformity
4 = Definite sclerosis and deformity
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38
Q

Anderson Orthopaedic Research Institute (AORI) Classification of Femoral and tibial bone defects in revision TKR

A

Type 1: Minor defects, intact metaphyses, Stability not compromised
Type 2: Metaphyseal bone damage
Type 3: Massive bone loss, ligaments may be involved

Type 1: Cement fill
Type 2: Augments
Type 3: Complex recon (sleves, tantalum, custom implants, megaprosthesis)

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39
Q

Lewis and Rorabeck Classification of TKR fractures

A

Type I = Nondisplaced, Component intact
Type II = Displaced, Component intact
Type III = Displaced, Component loose

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40
Q

Su and Associates Classification of Supracondylar fractures of TKR femur

A

Type I = Proximal to femoral component
Type II = Fracture starts at the proximal edge of the femoral component and goes proximal
Type III = Fracture is distal to the proximal edge of the femoral component

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41
Q

Felix and Associates’ Classification of Periprosthetic Tibia fractures in TKR

A

Type I = Tibial plateau
Type II = Stem
Type III = Shaft, distal to stem
Type IV = Tibial Tubercle

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42
Q

Goldberg Classification of Patellar resurfacing fracture in TKR

A

Type I = Fracture not involving the implant, cement or quads mechanism
Type II = Fracture of the implant / cement interface AND/OR quads mechanism
Type IIIa = Inferior pole WITH patellar ligament rupture
Type IIIb = Inferior pole WITHOUT patellar ligament rupture
Type IV = All fractures associated with a dislocation

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43
Q

Watanabe Classificaton of Discoid Meniscus

A

Type I = Complete
Type II = Incomplete
Type III = Wrisberg variant (no posterior meniscotibial attachment)

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44
Q

Clanton Classification of Osteochondritis Dissecans

A

Type I = Depressed fracture
Type II = Bony bridge attachment
Type III = Undisplaced detached
Type IV = Displaced fragment

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45
Q

Severity Grading of Hallux Valgus deformity

A 
Mild = HVA < 25, IMA < 13
Moderate = HVA = 40, IMA = 15
Severe = HVA > 40, IMA > 15

or remember:

Moderate: HVA 26-40, IMA 13-15

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46
Q

Johnson and Strom of Tibialis Posterior Tendon Insufficiency

A

Stage I = Tenosynovitis
Stage II = Flatfoot
Stage III = Subtalar OA
Stage IV = Ankle OA

Stage IIa = < 40% talar neck uncoverage
Stage IIb = > 40% talar neck uncoverage

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47
Q

Wagner Classification of Diabetic Foot Ulcers

A 
Grade 0 = No ulcer, but "foot at risk"
Grade 1 = Superficial ulcer
Grade 2 = Deep ulcer
Grade 3 = Abscess or Osteomyelitis with deep ulcer
Grade 4 = Partial Gangrene
Grade 5 = Extensive Gangrene
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48
Q

Brodsky Depth and Ischeamia Classification of Diabetic Foot Ulcers

A 
Depth:
Grade 0 = No ulcer, but "foot at risk"
Grade 1 = Superficial ulcer
Grade 2 = Deep ulcer
Grade 3 = Abscess or extensive ulcer
Ischaemia:
Type A = No ischaemia
Type B = Ischaemia, No gangrene
Type C = Partial gangrene
Type D = Complete gangrene
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49
Q

Coughlin and Shurnas Classification of Hallux Rigidus

A

Grade 0 = Normal XR, Mild stiffness
Grade 1 = Small dorsal osteophyte, Pain at extremes of motion
Grade 2 = Dorsal osteophyte <50% joint space narrowing
Grade 3 = Dorsal osteophyte >50% joint space narrowing
Grade 4 = Pain at mid-range of ROM, XR same as 3

50
Q

Brodsky Anatomical Classification of Charcot Foot Arthropathy

A

Type 1 = Tarsometatarsal and Naviculocuneiform joints
Type 2 = Subtalar, Talonavicular and Calcaneocuboid
Type 3A = Tibiotalar
Type 3B = Calcaneal tuberosity fracture
Type 4 = Combination of the above
Type 5 = Forefoot

51
Q

Eichenholtz Staging Classification of Charcot Foot Arthropathy

A

Stage 0 = Joint edema
Stage 1 = Fragmentation (Fracture)
Stage 2 = Coalescence (Resorption)
Stage 3 = Reconstruction (Healing)

52
Q

Sangeorzan Classification of Navicular body fractures

A

Type I = No deformity (dorsal or transverse fracture)
Type II = ADDuction deformity (Oblique fracture)
Type III = ABDuction deformity (Lateral or central comminution)

53
Q

Coughlin Classification of 5th Metatarsal Bunionette

A

Type I = Lateral exostosis
Type II = Metatarsal bowing (congenital)
Type III = Increased IMA 4-5 (most common)

Type I = exostectomy
Type II = distal osteotomy (chevron)
Type III = proximal osteotomy (Ludlof)

54
Q

Young-Burgess Classification of Open-book Pelvis fractures

A

Anterior-Posterior Compression
Lateral Compression
Vertical Shear

APC I = Symphysis widening <2.5 cm
APC II = Symphysis widening >2.5 cm, Anterior SI ligaments disrupted
APC III = Symphysis widening >2.5 cm, Anterior and Posterior SI ligaments disrupted

LC I = Ramus fracture and ipsilateral anterior SI compression fracture
LC II = Ramus fracture and ipsilateral posterior SI fracture dislocation (crescent fracture)
LC III = Ipsilateral LC and contralateral APC (windswept pelvis)

Vertical shear 25% mortality rate

55
Q

Glasgow coma score

A

Best Motor 6
Best Verbal 5
Best Eye opening 4

Motor:
6 = Obeys
5 = Localizes pain
4 = Normal flexion withdrawal
3 = Abnormal flexion withdrawal (decorticate)
2 = Abnormal extension withdrawal (decerebrate)
1 = None

Verbal:
5 = Oriented
4 = Confused
3 = Words only
2 = Sounds only
1 = None
Eyes:
4 = Spontaneous
3 = To speech
2 = To pain
1 = None
56
Q

Tile Classification of Open-book Pelvis Fractures

A

A: Stable
B: Rotationally unstable, Vertically stable
C: Rotationally and Vertically unstable

Highly classified into types and subtypes

57
Q

Blauth Classification of Thumb Hypoplasia

A 
Type I = small normal thumb
Type II = MCP instability, thenar muscle hypoplasia
Type IIIA = CMC intact
Type IIIB = CMC deficient
Type IV = Floating thumb (by skin only)
Type V = Complete absence

Type I = no surgery
Type II and IIIA = Reconstruction
Type IIB and IV = Pollicization of the index finger

58
Q

Bayne and Klug Classification of Radial Clubhand

A

Type I = Distal epiphysis deficient
Type II = Distal and proximal epiphyses deficient
Type III = Proximal half aplasia
Type IV = Complete absence

59
Q

Bayne Classification of Ulnar Clubhand

A

Type 0 = Deficiencies of carpus and hand only
Type 1 = Small ulna, both growthplates intact
Type 2 = Part of the ulna absent (usually distal)
Type 3 = Complete absence
Type 4 = RadioHumeral synostosis

60
Q

Wassel Classification of Preaxial (Thumb) Polydactyly

A

Type I = Bifid Distal phalanx
Type III = Bifid Proximal phalanx
Type V = Bifid Metacarpal
Type VII = Triphalangia

Type II = Duplicated Distal phalanx
Type IV = Duplicated Proximal phalanx (most common)
Type VI = Duplicated Metacarpal

61
Q

Ogden Classification of Pediatric Tibial Tubercle Fractures

A

Type I = Through Eminence fracture
Type II = Between Eminence and Tibial ossification centers
Type III = Through eminence and Tibial ossification centers
Type IV = Through the Tibial Physis
Type V = Periosteal sleeve avulsion from Eminence

Type III and IV need arthroscopy or arthrotomy during ORIF

62
Q

Judet and Letournel Classification of Acetabular Fractures

A

Elementary and Associated

Elementary:
Posterior Wall (PW)
Posterior Column (PC)
Anterior Wall (AW)
Anterior Column (AC)
Transverse (T)

Associated:
Associated Both Column = AC + PC (spur sign on OO view)
Posterior Column + Posterior Wall = PC + PW
Anterior Column + Posterior HemiTransverse = AC + T(half)
Transverse + Posterior Wall = T + PW
T-Type = T + inferior

T
T + PW
      PW + PC
                PC + AC
                         AC + T(half)
63
Q

Langenskiold Classification of Infantile Blount’s disease

A

Stage I = Beaking of the medial metaphysis
Stage II = Saucer-shaped metaphyseal defect
Stage III = Step-shaped metaphyseal defect
Stage IV = Sloped epiphysis over metaphyseal defect
Stage V = Double epiphysis
Stage VI = Bony bar medially

Surgery for Stage III in over 3 year old
Drennan angle > 16
Stages by Ages (higher stage at older age)
Stage I at 2, Stage III at 4, Stage V at 9.

64
Q

Lauge-Hansen Classification of Bimalleolar ankle fractures

A

SAD - Supination ADduction - Vertical medial mal
SER - Supination External Rotation - Transverse medial mal
Fibula fractures are at or below level of syndesosis in the above

PAB - Pronation ABducton - Talus in syndesmosis
PER - Pronation External Rotation - Talus not in syndesmosis
Fibula fracture is high Weber C in the above

65
Q

Weber Classification of Fibula fractures

A 
A = Below syndesmosis
B = At the syndesmosis
C = Above syndesmosis
66
Q

Schatzker Classification of Tibial Plateau Fractures

A 
Type I = Split Lateral
Type II = Split Depression Lateral
Type III = Pure Depression Lateral
Type IV = Medial
Type V = Bicondylar
Type VI = Metaphyseal - diaphyseal dissociation
67
Q

Hohl and Moore Classification of proximal tibia fracture dislocations (plateau fractures)

A 
Type I = Coronal split
Type II = Condyle fracture
Type III = Rim avulsion
Type IV = Rim compression
Type V = Four part
68
Q

Sanders Classification of Calcaneal fractures

A

Type I = Nondisplaced
Type II = Two fragments (one fracture line)
Type III = Three fragments
Type IV = Comminuted

Type = Number of fragments (you get pieces of chicken at KFC, not lines)

69
Q

Beavis Classification of Calcaneal avulsions of the Achilles

A

Type 1 = Sleeve (shell of bone)
Type 2 = Beak
Type 3 = Infrabursal fracture (small fracture fragment)

70
Q

Garden Classification of Femoral neck fractures

A

Type I = Valgus impacted (Incomplete)
Type II = Nondisplaced (Complete)
Type III = Partially displaced
Type IV = Fully displaced

71
Q

Pauwels’ Classification of Femoral neck fractures

A

Type I = < 30 degrees from Horizontal
Type II = 30 to 50
Type III = > 50 degrees from Horizontal

72
Q

Neer Classification of Proximal Humerus Fractures

A 
Minimally displaced
Two part
Three part
Four part
Articular segment fracture (head split)

Part = 1 cm or 45 degrees. Shaft, GT, LT, Articular surface

73
Q

Mason Classification of Radial Head Fractures

A

Type I = Undisplaced (< 2mm)
Type II = Displaced or angulated
Type III = Comminuted and displaced
Type IV = Fracture + elbow dislocation (added on by Broberg and Morrey)

74
Q

Cierny-Mader Classification of Osteomyelitis

A

Stage I = Intramedullary
Stage II = Superficial
Stage III = Localized
Stage IV = Diffuse (unstable)

Type A Host = Normal
Type BL host = Locally compromised
Type BS host = Systemically compromised
Type C host = Treatment worse that the disease

75
Q

Milch Classification of Lateral condyle fractures of the humerus

A

Type I = Lateral trochlea intact

Type II = Fracture through lateral trochlea

76
Q

Gartland Classification of Supracondylar elbow fractures in Paeds

A

Type I = Nondisplaced
Type II = Displaced, but posterior cortex / hinge intact
Type III = Completely displaced (no posterior contact)

Added on:
Type IIb = Rotated (but posterior cortex intact)
Type IV = Circumferential periosteal disruption
Flexion type
Medial comminution (in any type)
77
Q

Weiss Classification of Lateral Epicondyle Fracture displacement in Paeds

A

Type 1 = <2mm displacement (implies intact cartilage hinge)
Type 2 = 2 - 4mm displacement, Intact cartilage hinge on Arthrogram
Type 3 = >4mm displacement, Disrupted articular hinge on Arthrogram

78
Q

O’Brien Classification of Paediatric radial head fractures

A

Type I = < 30 degrees angulation
Type II = 30-60 degrees
Type III = > 60 degrees angulation

79
Q

Bado Classification of Monteggia fractures

A

Type I = Anterior radial head dislocation
Type II = Posterior
Type III = Lateral
Type IV = Fracture of the radius and ulna at the same level + Anterior radial head dislocation

Type I = Immobilize in Flexion and supination (relax biceps)
Type II = Immobilize in Extension
Type III = Extension + Valgus mold
Type IV = ORIF

80
Q

Meyers and McKeever Classification of Tibial eminence fractures in Paeds

A

Type I = Undsiplaced
Type II = Anterior displaced, Posterior hinge intact
Type III = Anterior and Posterior displaced (III+ if rotated)
Type IV = Comminuted + Displaced

81
Q

Radiographic Classification of Paediatric Osteomyelitis

A 
Type I = Lucency
Type II = Metaphyseal lesion with cortical bone loss
Type III = Diaphyseal lesion
Type IV = Onion skinning
Type V = Epiphyseal lesion
Type VI = Spinal lesion
82
Q

Graf Classification of DDH on Ultrasound

A

Class I = Alpha > 60, Beta < 55
Class II = Alpha > 43, Beta < 77
Class III = Alpha < 43, Beta > 77
Class IV = Unmeasurable (dislocated)

Ultrasound can be spurious if done before 4-6 weeks
Alpha = BONY acetabulum and Ilium
Beta = CARTILAGINOUS labrum and ilium

83
Q

Waldenstrom Stages of Pethes disease

A

Initial - small epiphysis (3m to 6m)
Fragmentation - head resorption and collapse (6m to 24m)
Reossification - new bone formation (up to 18m)
Remodeling - trabecular pattern returns (until skeletal maturity)

84
Q

Herring Classification of Perthes disease

A

Group A = 100% lateral pillar height
Group B = > 50% lateral pillar height
Group C = < 50% lateral pillar height
B/C border = 50% lateral pillar height + narrow epiphysis

Based on Fragmentation stage (Waldenstrom 6m to 24m)
Group A = good outcome - non-op
Group C = bad outcome - non-op

85
Q

Catterall Classification of Perthes diesase

A

Group I = Anterior only involved
Group II = Anterior and central involved
Group III = Most of the head involved
Group IV = All of the head involved

86
Q

Catterall Head at risk signs of Perthes disease

A

Subluxation (of the femoral head laterally)
Calcification (lateral to the epiphysis)
Horizontal physis
Gage’s sign (Lateral V-shaped lucency)
Cyst (metaphyseal) (added on to Catterall original 4)

87
Q

Differential Diagnoses for Perthes diesease

A

Infection
Transient synovitis
Multiple epiphyseal dysplasia (symmetrical involvement)
Spondyloepiphyseal dysplasia (spine involved)
Sickle cell diesease
Gaucher disease
Hypothyroidism
Meyer’s dysplasia (occurs at 2-3 years old)

88
Q

Loder Classification of SCFE

A 
Stable = Able to bear weight*
Unstable = Unable to bear weight**

*With or without crutches
*Even with crutches
Stable = < 10% osteonecrosis risk
Unstable = 24 - 47% osteonecrosis risk

89
Q

Southwick Classification of SCFE

A

Slip angle difference (side to side)
Mild = < 30
Moderate = < 50
Severe = > 50

Angle between epiphysis and diaphysis
If bilateral slip:
Use 145 as normal on AP
Use 10 as normal on lateral

90
Q

Percentage of slip Classification in SCFE

A

Grade I = < 33 %
Grade II = < 50 %
Grade III = > 50 %

91
Q

What is Drehmann sign

A

Obligate external rotation of the hip during flexion in SCFE

92
Q

What is Klein’s line

A

Line along superior border of the femoral neck. It should go through part of the epiphysis. It does not touch the epiphysis in SCFE.

93
Q

What is the Blanch sign of Steel

A

Blurring of the femoral neck metaphysis due to SCFE overlap on AP xray.

94
Q

Risk factors for contralateral SCFE

A

Slip at age < 10 years
Open triradiate cartilage
Obese male
Endocrine disorders (hypothyroidism)

95
Q

Name 3 osteotomies (and their locations) used for post-SCFE deformity

A

Cuneiform (Femoral neck - high AVN and OA rate)
Imhauser (Intertrochanteric - creates flexion, IR and valgus)
Southwick (Subtrochanteric)

96
Q

Ruedi and Allgower Classification of Tibial Pilon fractures

A

Type I = Nondisplaced
Type II = Displaced
Type III = Comminuted

97
Q

GMFCS levels in CP

A 
1 = Clumsy (can do normal things but slower)
2 = Difficulty with obstacles (stairs, crowds, uneven surfaces)
3 = Assistive device necessary most of the time
4 = Wheelchair most of the time (or walker for short distances)
5 = No head control
98
Q

ASIA impairment scale

A 
A = Complete
B = Sensory incomplete / Motor complete
C = Motor incomplete (grade 2 or less in most muscle groups)
D = Motor incomplete (grade 3 or more in most muscle groups)
E = Normal
99
Q

Physiologic Classification of Cerebral Palsy

A 
Spastic - velocity dependant rigidity
Hypotonic - often precedes Spas or Atax by 2 years
Athetoid - Slow writhing movements
Ataxic - Ucoordinated
Mixed - Usually Spastic and Athetoid

SHAAM

100
Q

Anatomic Classification of Cerebral Palsy

A

Diplegic - lower limbs
Hemiplegic - one side of the body
Quadriplegic - whole body

101
Q

Reimer’s migration index

A

Percent of femoral head that is uncovered.
Measure width of femoral head
Draw Perkin’s line
Measure the percent of femoral head lateral to Perkin’s line

Most useful in CP
< 33 = do tenotomies, botox
> 33 = do osteotomies + tenotomies
> 100% = do open reduction + osteotomies + tenotomies

102
Q

Sillence Classification of Osteogenesis Imperfecta

A

Type I = AD, Quant of collagen, Mild form, Blue sclerae
Type II - AR, Qual, Lethal, Blue
Type III = AR, Qual, Severe survivable, White sclerae
Type IV = AD, Qual, Moderate, White sclerae

Types V to VII have been added, they are not due to Type I collagen, but have similar morphology.

103
Q

Delbet Classification of Proximal femoral fractures in Paeds

A

Type I = Transphyseal (40-100% AVN)
Type II = Transcervical (30% AVN)
Type III = Basicervical (20% AVN)
Type IV = Intertrochanteric (5% AVN)

104
Q

Mercer Rang’s Stages of Cerebral Palsy deformities

A

Stage 1 = Dynamic contractures (bracing / botox)
Stage 2 = Fixed muscle contractures (tendon lengthen or transfer)
Stage 3 = Fixed bone / joint contracture (osteotomy / arthrodesis)

105
Q

Pirani score for Talipes Eqinovarus

A

Look, Feel, Move

Look (3)

  • Posterior crease
  • Medial crease
  • Lateral curvature

Fell (2)

  • Head of talus
  • Empty heel

Move (1)
- Dorsiflexion range

Score each as 0, 0.5 or 1
Total score out of 6

106
Q

Schatzker Classification of Olecranon fractures

A 
A = Simple transverse
B = Impacted transverse
C = Oblique
D = Comminuted
E = Distal extra-articular
F = Dislocation
107
Q

Schenck Classification of Knee Dislocations

A

KD 1 = ACL or PCL involved (Multilig injury though)
KD 2 = ACL and PCL only
KD 3 = ACL and PCL + Medial (MCL) or Lateral (LCL and PLC)
KD 4 = ACL and PCL and MCL and PLC/LCL (highest rate of vascular injury)
KD 5 = Fracture + Multilig

108
Q

Hawkins (modified) Classification of Talar neck fractures

A 
1 = Nondisplaced
2 = Subtalar dislocation
3 = Subtalar and Tibiotalar dislocation
4 = Subtalar, Tibiotalar and Talonavicular dislocation

Non
Below
Above and Below
Total

109
Q

Ficat Classification of Hip AVN

A

Stage 0 - Preclinical, normal XR, MRI positive
Stage 1 - Painful, normal XR, MRI positive
Stage 2 - Crescent sign, diffuse sclerosis
Stage 3 - Collapse / Flattening
Stage 4 - Arthritis with deformed head

110
Q

Larsen Classification of Rheumatoid Arthritis

A
  1. Soft tissue only, Normal XR
  2. Periarticular erosion, osteopenia
  3. Joint space narrowing
  4. Advanced erosion through the subchondral plate
  5. Advanced joint damage

(of the elbow)

111
Q

Pipkin Classification of Femoral Head Fractures

A

Type 1: Below the fovea
Type 2: Above the fovea
Type 3: Neck fracture associated
Type 4: Acetabular fracture associated

This is a subclassification of the Stewart and Milford Type 4 dislocations of the hip

Note: Better results with excision of small fragment in Type 1 than with ORIF.
Type 3 has high AVN rate, use THR if >60 years old.
Type 4: consider using posterior approach to fix acetabulum +/- Trochanteric osteotomy to get anterior to fix head.

112
Q

Coventry Classification of Fibular Hemimelia

A

Type 1: Unilateral Incomplete absence (of fibula)
Type 2: Unilateral Complete absence (of fibula +/- lateral rays)
Type 3: Bilateral (Severe, usually PFFD and upper limb deficiencies)

113
Q

Evans Classification of Intertrochanteric fractures

A

Type 1 - Intertrochanteric
Type 2 - Reverse Oblique

Type 1 subdivision:

  1. 2 part undisplaced
  2. 2 part displaced
  3. 3 part with GT fracture
  4. 3 part with LT fracture (unstable)
  5. 4 part (GT and LT fracture - unstable)
114
Q

Shapiro Patterns of LLD

A
  1. Increasing (Constant) (Up slope) - Hemihypertrophy
  2. Increasing Plateau (Decelerating) (Up slope, gradual plateau) - Perthes
  3. Plateau (Stopping) (Up slope, abrupt plateau) - Fracture femur
  4. Increasing Decreasing (Up slope, plateau, up slope) - no good example (?DDH)
  5. Decreasing (Up slope, plateau, down slope) - no good example
115
Q

Wiltse Classification of Lumbar Disc Herniations

A
  1. Bulge
  2. Protrusion
  3. Extrusion
  4. Sequestration
Bulge:
Annulus intact
Protrusion:
Smaller disc material than aperture
Extrusion:
Larger disc material than aperture
Sequestration:
No continuity disc material with disc proper
116
Q

Palmer Classification of TFCC lesions

A

Class 1 = Traumatic
Class 2 = Degenerative

Class 1
A. Central
B. Ulnar avulsion
C. Carpal avulsion
D. Radial avulsion
Class 2
A. TFCC Wear
B. TFCC + Lunate or Ulnar Wear
C. TFCC Tear
D. TFCC Tear + LT ligament tear
E. TFCC Tear + arthritis
117
Q

Levine and Edwards (or Starr) classification of Hangman’s fractures

A
  1. <3 mm subluxation
    2a. >3 mm subluxation, Vertical fracture line
    2b. >3 mm subluxation, Horizontal fracture line, Angulation of C2 body
  2. Bilateral facet dislocations as well as angulation and translation

Hangman’s = C2/3 spondylolisthesis

118
Q

King LiTTLe Thoracic Curve Deformity classification of scoliosis

A

LTTL TCD

Lumbar with Thoracic compensation
Thoracic with Lumbar compensation
Thoracic only
C-shaped curve
Double thoracic
119
Q

Fielding Hawkins Classification of Atlanto-axial rotatory instability

A

Type 1: rotation without subluxation
Type 2: one facet injured
Type 3: transverse ligament and both facets injured
Type 4: posterior displacement of atlas

Type 1: ADI <3. Halter traction for one week.
Type 2: ADI 3-5. Traction then halo.
Type 3: ADI > 5. Traction then fusion.
Type 4: rare. Seek specialist opinion.

120
Q

Anderson and Montesano classification of occipital condyle fractures

A

Type 1: comminuted
Type 2: skull base
Type 3: avulsion

Type 1: from crushing axial load. Stable.
Type 2: extension into skull base. Stable.
Type 3: disruption of alar ligament / tectorial membrane. Probably unstable. Occipitalcervical fusion.

121
Q

Atlas fractures classification

A

Type 1: posterior arch
Type 2: lateral mass
Type 3: jefferson burst

Transverse ligament determines stability, suspect if:
ADI >3 (on flex/ext views)
Lateral displacement of lateral masses >8.1mm

Halo for 12 weeks or fusion

122
Q

Hardcastle classification of Lisfranc injuries

A 
A = Total homolateral
B = Partial
C = Divergent
B1 = Medial column isolated
B2 = Lateral column isolated
C1 = Partial (not all rays)
C2 = Total (all rays involved)

Alexey Ortho Flashcards (21 decks)

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