Classification Systems Flashcards
Enneking Staging of Benign Bone Tumors
1 = Latent lesion 2= Active lesion 3= Aggressive lesion
Latent = NOF, Enchondroma Active = ABC, UBC, ChondroMyxoid Fibroma, Chondroblastoma Aggressive = Giant cell tumor
Enneking Staging of Malignant Bone Tumors
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
Bigliani Classification of Acromial Morphology
Type I = Flat
Type II = Curved
Type III = Hooked
Based on supraspinatus outlet view
Poor interobserver reliability
Goutallier Grading of Rotator Cuff Atrophy
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
Seebauer Classification of Rotator Cuff Arthropathy
Type IA = Centered, Stable
Type IB = Centered, Medialized
Type IIA = Decentered, Stable
Type IIB = Decentered, Unstable
Hamada Classification of Rotator Cuff Arthropathy
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
Walch Classification of Glenoid Wear
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)
Cruess Staging of Humerus AVN
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
SLAP tear Classification
Snyder includes Types 1 to 4
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)
Neer Classification of Distal Clavicle Fractures
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)
Ideberg Classification of Glenoid Fractures
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
Hertel Predictors of Humeral Head Ischaemia
<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
Ogawa Classification of Coracoid Fractures
Type I = Posterior to CC ligaments (surgery)
Type II = Anterior to CC ligaments (non-op)
Kuhn Classification of Acromial Fractures
Type Ia = avulsion fractures
Type Ib = minimally displaced
Type II = displaced, subacromial space not compromised
Type III = displaced, subacromial space compromised
Classification of Prosthetic Joint Infections
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
Wright and Cofield Classification of Periprosthetic Proximal Humerus Stem fractures
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
Serveaux Classification of Scapular Notching in RTSR
Grade 1 = Scapular pillar
Grade 2 = Inferior screw and baseplate
Grade 3 = Beyond the inferior screw
Grade 4 = Approaches central peg
Leddy and Packer Classificaiton of FDP tendon avulsions
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)
Doyle’s Classification of Mallet Finger injuries
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%
Mayfield Classification of Peri-Lunate Dislocations
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
Herzberg Classification of Peri-lunate Dislocations
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
Seddon Classification of Nerve Injuries
Neuropraxia = Myelin damaged Axonotmesis = Axon damaged Neurotmesis = Nerve damaged
Sunderland further subdivides Neurotmesis
3 = Endoneurium damaged
4 = Perineurium damaged
5 = Epineurium damaged
Green Classification of Trigger Finger
Grade 1 = Pain and tenderness
Grade 2 = Catching
Grade 3 = Locking
Grade 4 = Locked
Eaton and Littler Classification of Basilar Thumb Arthritis
Stage I = Widening
Stage II = <2 mm osteophytes
Stage III = >2mm osteophytes
Stage IV = Pantrapezial (STT involved)
Lichtman Classification of Lunate AVN
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
Lichtman Classification of Lunate AVN
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
Radiographic Stages of SNAC wrist
Stage I = Radial styloid arthritis
Stage II = Scapho-Capitate arthritis
Stage III = Peri-Scaphoid arhritis
Bayne and Klug Classification of Radial Clubhand
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)
Steinberg (modified Ficat) Classification of Femoral Head AVN
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
Musculoskeletal Infection Society (MSIS) 2018 criteria for prosthetic joint infection
1 Major OR 6 Minor = Infected
0-1 Minor = Not infected
Major:
- Sinus tract to prosthesis
- 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
Vancouver Intraoperative Femur fracture Classification
A = Metaphysis B = Diaphysis (around stem) C = Distal to stem
Subclass for each 1 = Cortical perforation 2 = Undisplaced fracture 3 = Unstable fracture
Vancouver Postoperative Femur fracture Classification
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
AAOS Classification of Acetabular bone loss
I = Segmental II = Cavitary III = Combined (segmental and cavitary) IV = Pelvic discontinuity (superior acetabulum separate from inferior) V = Arthrodesis
Paprosky Classification of Acetabular bone loss
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
AAOS Classification of Proximal Femoral bone loss
I = Segmental II = Cavitary III = Combined IV = Malalignment V = Stenosis VI = Discontinuity
Paprosky Classification of Femoral bone loss
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
Kellgren and Lawrence Classification of Knee OA
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
Anderson Orthopaedic Research Institute (AORI) Classification of Femoral and tibial bone defects in revision TKR
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)
Lewis and Rorabeck Classification of TKR fractures
Type I = Nondisplaced, Component intact
Type II = Displaced, Component intact
Type III = Displaced, Component loose
Su and Associates Classification of Supracondylar fractures of TKR femur
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
Felix and Associates’ Classification of Periprosthetic Tibia fractures in TKR
Type I = Tibial plateau
Type II = Stem
Type III = Shaft, distal to stem
Type IV = Tibial Tubercle
Goldberg Classification of Patellar resurfacing fracture in TKR
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
Watanabe Classificaton of Discoid Meniscus
Type I = Complete
Type II = Incomplete
Type III = Wrisberg variant (no posterior meniscotibial attachment)
Clanton Classification of Osteochondritis Dissecans
Type I = Depressed fracture
Type II = Bony bridge attachment
Type III = Undisplaced detached
Type IV = Displaced fragment
Severity Grading of Hallux Valgus deformity
Mild = HVA < 25, IMA < 13 Moderate = HVA = 40, IMA = 15 Severe = HVA > 40, IMA > 15
or remember:
Moderate: HVA 26-40, IMA 13-15
Johnson and Strom of Tibialis Posterior Tendon Insufficiency
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
Wagner Classification of Diabetic Foot Ulcers
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
Brodsky Depth and Ischeamia Classification of Diabetic Foot Ulcers
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
Coughlin and Shurnas Classification of Hallux Rigidus
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
Brodsky Anatomical Classification of Charcot Foot Arthropathy
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
Eichenholtz Staging Classification of Charcot Foot Arthropathy
Stage 0 = Joint edema
Stage 1 = Fragmentation (Fracture)
Stage 2 = Coalescence (Resorption)
Stage 3 = Reconstruction (Healing)
Sangeorzan Classification of Navicular body fractures
Type I = No deformity (dorsal or transverse fracture)
Type II = ADDuction deformity (Oblique fracture)
Type III = ABDuction deformity (Lateral or central comminution)
Coughlin Classification of 5th Metatarsal Bunionette
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)
Young-Burgess Classification of Open-book Pelvis fractures
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
Glasgow coma score
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
Tile Classification of Open-book Pelvis Fractures
A: Stable
B: Rotationally unstable, Vertically stable
C: Rotationally and Vertically unstable
Highly classified into types and subtypes
Blauth Classification of Thumb Hypoplasia
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
Bayne and Klug Classification of Radial Clubhand
Type I = Distal epiphysis deficient
Type II = Distal and proximal epiphyses deficient
Type III = Proximal half aplasia
Type IV = Complete absence
Bayne Classification of Ulnar Clubhand
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
Wassel Classification of Preaxial (Thumb) Polydactyly
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
Ogden Classification of Pediatric Tibial Tubercle Fractures
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
Judet and Letournel Classification of Acetabular Fractures
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)
Langenskiold Classification of Infantile Blount’s disease
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.
Lauge-Hansen Classification of Bimalleolar ankle fractures
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
Weber Classification of Fibula fractures
A = Below syndesmosis B = At the syndesmosis C = Above syndesmosis
Schatzker Classification of Tibial Plateau Fractures
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
Hohl and Moore Classification of proximal tibia fracture dislocations (plateau fractures)
Type I = Coronal split Type II = Condyle fracture Type III = Rim avulsion Type IV = Rim compression Type V = Four part
Sanders Classification of Calcaneal fractures
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)
Beavis Classification of Calcaneal avulsions of the Achilles
Type 1 = Sleeve (shell of bone)
Type 2 = Beak
Type 3 = Infrabursal fracture (small fracture fragment)
Garden Classification of Femoral neck fractures
Type I = Valgus impacted (Incomplete)
Type II = Nondisplaced (Complete)
Type III = Partially displaced
Type IV = Fully displaced
Pauwels’ Classification of Femoral neck fractures
Type I = < 30 degrees from Horizontal
Type II = 30 to 50
Type III = > 50 degrees from Horizontal
Neer Classification of Proximal Humerus Fractures
Minimally displaced Two part Three part Four part Articular segment fracture (head split)
Part = 1 cm or 45 degrees. Shaft, GT, LT, Articular surface
Mason Classification of Radial Head Fractures
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)
Cierny-Mader Classification of Osteomyelitis
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
Milch Classification of Lateral condyle fractures of the humerus
Type I = Lateral trochlea intact
Type II = Fracture through lateral trochlea
Gartland Classification of Supracondylar elbow fractures in Paeds
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)
Weiss Classification of Lateral Epicondyle Fracture displacement in Paeds
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
O’Brien Classification of Paediatric radial head fractures
Type I = < 30 degrees angulation
Type II = 30-60 degrees
Type III = > 60 degrees angulation
Bado Classification of Monteggia fractures
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
Meyers and McKeever Classification of Tibial eminence fractures in Paeds
Type I = Undsiplaced
Type II = Anterior displaced, Posterior hinge intact
Type III = Anterior and Posterior displaced (III+ if rotated)
Type IV = Comminuted + Displaced
Radiographic Classification of Paediatric Osteomyelitis
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
Graf Classification of DDH on Ultrasound
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
Waldenstrom Stages of Pethes disease
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)
Herring Classification of Perthes disease
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
Catterall Classification of Perthes diesase
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
Catterall Head at risk signs of Perthes disease
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)
Differential Diagnoses for Perthes diesease
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)
Loder Classification of SCFE
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
Southwick Classification of SCFE
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
Percentage of slip Classification in SCFE
Grade I = < 33 %
Grade II = < 50 %
Grade III = > 50 %
What is Drehmann sign
Obligate external rotation of the hip during flexion in SCFE
What is Klein’s line
Line along superior border of the femoral neck. It should go through part of the epiphysis. It does not touch the epiphysis in SCFE.
What is the Blanch sign of Steel
Blurring of the femoral neck metaphysis due to SCFE overlap on AP xray.
Risk factors for contralateral SCFE
Slip at age < 10 years
Open triradiate cartilage
Obese male
Endocrine disorders (hypothyroidism)
Name 3 osteotomies (and their locations) used for post-SCFE deformity
Cuneiform (Femoral neck - high AVN and OA rate)
Imhauser (Intertrochanteric - creates flexion, IR and valgus)
Southwick (Subtrochanteric)
Ruedi and Allgower Classification of Tibial Pilon fractures
Type I = Nondisplaced
Type II = Displaced
Type III = Comminuted
GMFCS levels in CP
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
ASIA impairment scale
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
Physiologic Classification of Cerebral Palsy
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
Anatomic Classification of Cerebral Palsy
Diplegic - lower limbs
Hemiplegic - one side of the body
Quadriplegic - whole body
Reimer’s migration index
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
Sillence Classification of Osteogenesis Imperfecta
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.
Delbet Classification of Proximal femoral fractures in Paeds
Type I = Transphyseal (40-100% AVN)
Type II = Transcervical (30% AVN)
Type III = Basicervical (20% AVN)
Type IV = Intertrochanteric (5% AVN)
Mercer Rang’s Stages of Cerebral Palsy deformities
Stage 1 = Dynamic contractures (bracing / botox)
Stage 2 = Fixed muscle contractures (tendon lengthen or transfer)
Stage 3 = Fixed bone / joint contracture (osteotomy / arthrodesis)
Pirani score for Talipes Eqinovarus
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
Schatzker Classification of Olecranon fractures
A = Simple transverse B = Impacted transverse C = Oblique D = Comminuted E = Distal extra-articular F = Dislocation
Schenck Classification of Knee Dislocations
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
Hawkins (modified) Classification of Talar neck fractures
1 = Nondisplaced 2 = Subtalar dislocation 3 = Subtalar and Tibiotalar dislocation 4 = Subtalar, Tibiotalar and Talonavicular dislocation
Non
Below
Above and Below
Total
Ficat Classification of Hip AVN
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
Larsen Classification of Rheumatoid Arthritis
- Soft tissue only, Normal XR
- Periarticular erosion, osteopenia
- Joint space narrowing
- Advanced erosion through the subchondral plate
- Advanced joint damage
(of the elbow)
Pipkin Classification of Femoral Head Fractures
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.
Coventry Classification of Fibular Hemimelia
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)
Evans Classification of Intertrochanteric fractures
Type 1 - Intertrochanteric
Type 2 - Reverse Oblique
Type 1 subdivision:
- 2 part undisplaced
- 2 part displaced
- 3 part with GT fracture
- 3 part with LT fracture (unstable)
- 4 part (GT and LT fracture - unstable)
Shapiro Patterns of LLD
- Increasing (Constant) (Up slope) - Hemihypertrophy
- Increasing Plateau (Decelerating) (Up slope, gradual plateau) - Perthes
- Plateau (Stopping) (Up slope, abrupt plateau) - Fracture femur
- Increasing Decreasing (Up slope, plateau, up slope) - no good example (?DDH)
- Decreasing (Up slope, plateau, down slope) - no good example
Wiltse Classification of Lumbar Disc Herniations
- Bulge
- Protrusion
- Extrusion
- Sequestration
Bulge: Annulus intact Protrusion: Smaller disc material than aperture Extrusion: Larger disc material than aperture Sequestration: No continuity disc material with disc proper
Palmer Classification of TFCC lesions
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
Levine and Edwards (or Starr) classification of Hangman’s fractures
- <3 mm subluxation
2a. >3 mm subluxation, Vertical fracture line
2b. >3 mm subluxation, Horizontal fracture line, Angulation of C2 body - Bilateral facet dislocations as well as angulation and translation
Hangman’s = C2/3 spondylolisthesis
King LiTTLe Thoracic Curve Deformity classification of scoliosis
LTTL TCD
Lumbar with Thoracic compensation Thoracic with Lumbar compensation Thoracic only C-shaped curve Double thoracic
Fielding Hawkins Classification of Atlanto-axial rotatory instability
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.
Anderson and Montesano classification of occipital condyle fractures
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.
Atlas fractures classification
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
Hardcastle classification of Lisfranc injuries
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)
