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Classifications Flashcards

1
Q

Classification for Achilles Tendon Rupture

A

Kuwada

  • Type I: partial tear. tx = closed.
  • Type II: complete tear w/ defect after debridement less than 3 cm. tx = end to end attachment
  • Type III: complete tear w/ defect after debridement 3-6 cm. tx = end to end attachment and tendon flap
  • Type IV: complete tear with defect after debridement greater than 6 cm. tx = end to end, recession or graft
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2
Q

Classification Non-insertional achilles tendonitis

A

Paddu 1976

  • paratendintis= inflammation of lining of paratenon. Diffuse fusiform swelling, pain with motion adn with rubbing of tendon b/w finger and thumb, crepitus w/ gliding of skin over tendon.
  • Paratendinitis w/ tendinosis= inflammation of the paratenon and intratendinous degeneration. Increased thickening and irregularity of the tendon, pain when tendon squeezed.
  • Tendinosis= non-inflammatory atrophic degeneration due to aging, microtrauma, or vascular compromise.
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3
Q

Classification for radiopaque lesions of achilles tendon

A

Morris and Giacopelli 1990

  • Type I: opacities at the achilles insertion. calcification in within the tendon and remains partially attached to calcaneus.
  • Type II: opacities 1-3 cm proximal to insertion. lesions are separate from calcaneus.
  • Type IIIA: lesions greater than 3 cm proximal to insertion. Partial tendon calcification.
  • Type IIIB: lesions greater than 3 cm proximal to insertion. Total tendon involvement.
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4
Q

Classification Peroneal Subluxation

A

Eckert and Davis 1976

  • Grade I: retinaculum ruptures from cartilaginous lip and lateral malleolus
  • Grade II: distal edge of fibrous lip is elevated with the retinaculum
  • Grade III: thin fragment of bone is avulsed from the deep surface of the peroneal retinaculum and deep fascia
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5
Q

Classification of longitudinal tears of peroneus brevis

A

Sobel

  • Grade I: splayed out
  • Grade II: partial thickness split greater than 1 cm
  • Grade III: full thickness split 1-2 cm
  • Grade IV: full thickness split greater than 2 cm
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6
Q

fracture stability - Charnley 1974

A
  • stable = transverse fractures
  • unstable = long oblique fractures and comminuted
  • potentially stable = short oblique fractures orientated less than 45 degrees from transverse axis
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7
Q

according to charney 1974, any fracture of the metatarsal shaft is …

A

unstable

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8
Q

Gustillo and Anderson open fracture classification 1976

A
  • Type I: open fracture with a wound less than 1 cm and clean. 0-2% risk of infection.
  • Type II: open fracture with laceration greater than 1 cm and extensive soft tissue damage. 2-7% risk of infection.
  • Type III: open fracture with extensive soft tissue damage.
  • IIIA: adequate soft tissue coverage. 7% risk of infection.
  • IIIB: extensive soft tissue damage with periosteal stripping. 50% risk infection
  • IIIC: open fracture assocaited with arterial injury requiring repair. 25-50% risk infection; 50% risk amputation
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9
Q

Ruedi and Allgower Classification 1979

A

Pilon fractures

  • Type I: mild displacement and no comminution without major disruption of ankle joint
  • Type II: moderate displacement and no comminution with significant displacement of ankle joint
  • Type III: ‘explosion fracture’ severe comminution and displacement of distal tibial metaphysis
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10
Q

what type of lauge-hansen MOI would create pilon fracture?

A

pronation-dorsiflexion (not one of the big 4)

  • stage I: medial malleolar fx or deltoid ligament rupture
  • stage II: fx of anterior lip tibial plafond
  • stage III: fibular fx above level of syndesmosis
  • stage IV: transverse fx of distal part of tibia at the same level as proximal margin of large tibial fracture
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11
Q

AO classification of pilon fractures

A
  • type A: extra-articular
  • type B: partially articular
  • type C: completely articular
  • all three can involve: 1)no comminution or impartion in the articular or metaphyseal surface OR 2) impaction involving the supra-articular metaphysis OR 3) comminution and impaction involving the articular surface with metaphyseal impaction
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12
Q

Destot Classification

A

tibia fractures

  • subgroup I: posterior marginal fx of tibia
  • subgroup II: anterior marginal fracture of tibia
  • subgroup III: explosion fracture of the tibia
  • subgroup IV: supra-articular fx of tibia with extension into ankle joint
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13
Q

Kellam and Waddell 1979

A

pilon fx classification

  • type A: rotational pattern consisting of 2 or more larger tibial fragments, minimal or no anterior cortical comminution, and a transverse or short oblique fibular fracture at teh level of tibial plafond
  • type B: compressive fx pattern with multiple tibial fragments with marked anterior tibial cortical comminution
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14
Q

Malle and Seligson 1980

A

pilon fx classification

  • type I: distal tibial compression fx
  • type II: external rotatry fx with large posterior fragments
  • type III: spiral fx extending from articular surface into metaphysis
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15
Q

Ovadia and Beals 1986

A

pilon fracture classification

type I: non-displaced articular fracture resulting from rotational forces

type II: minimally displaced fracture resulting from articular forces

type III: displaced articular fracture with several large fragments due to compressive forces

type IV: displaced articular fracture with multiple fragments including a large metaphyseal fragmen tresulting from compressive forces

type V: severe comminution due to compressive forces

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16
Q

Mast classification 1988

A

pilon fractures

  • type I: malleolar fx with significant axial load at the time of injury producing a large posterior fx
  • type II: spiral extension fracture
  • type III: central compressive injury divided into A, B, and C
17
Q

staged protocol pilon fx fixation

A

stage 1: immediate fixation of fibula and transarticlar fixation

stage 2: formal reconstruction of tibia, performed after soft-tissue stabilization and decreased edema has occurred

18
Q

Lauge Hansen Ankle Fracture Classification

A

SAD: supination-adduction

  • stage I: lateral: transverse fx of fibula below level of ankle joint or rupture of the lateral collateral ligaments
  • stage II: medial: near vertical fracture of medial malleolus

PAB: pronation-abduction

  • stage I: medial: transverse fx of medial malleolus or rupture of deltoid ligament
  • stage II: anterior: rupture of anterior and inferior tib-fiib ligaments
  • stage III: lateral: fibular fx at level of ankle joint with the appearance of a spiral fracture on the AP xray and a transverse fx on lateral x-ray

SER: supination-external rotation

  • stage I:anterior: rupture of AITFL or avulsion of ligament (wagstaffe/tillaux/chaput)
  • stage II: lateral: spiral fx of fibula with a posterior spike seen on lateral x-ray beginning at level of the ankle joint
  • stage III: posterior: rupture of PITFL or avulsion of ligament of posterior malleolus (volkmann’s)
  • stage IV: medial: avulsion fracture of medial malleolus or rupture of the deltoid ligament

PER: pronation-external rotation

  • stage I: medial: avulsion fx of medial malleolus or rupture of deltoid ligament
  • stage II: anterior: rupture or avulsion fx of AITFL or wagstaff/tillaux-chaput and rupture of interosseous membrane
  • stage III: lateral: short oblique fibular fx starting above the ankle jt and extending up the fibula depending on the extent of the interosseous rupture. fracture runs distal posterior to proximal anterior.
  • stage IV: rupture or avulsion fx of PITFL/volkmann’s
19
Q

what level of anatomy is used to define danis-weber classifications?

A

syndesmosis

20
Q

Danis-weber classification 1980

A
  • type A: transverse avulsion fracture of the fibula beginning below the syndesmosis (SAD)
  • type B: spiral, oblique fracture of fibula beginning at the levvel of syndesmosis (SER/PAB)
  • type C: fracture of the fibula beginning above the level of the syndesmosis (PER)
21
Q

when is non-op treatment indicated for ankle fx?

A

isolated fibular fx with less than 2 mm displacement and no tenderness of medial malleolus (deltoid)

tx = short leg cast WB 6 wks

22
Q

when should a posterior malleolar fracture be fixated with ORIF?

A
  • If less than 30% articular area = vassal’s principles
  • if greater than 30% articular area = ORIF with anterior approach and 1/2 cannulated screws
23
Q

what is cotton’s test?

A

The examiner stabilizes the proximal ankle while shifting the talus laterally. A positive test is marked by increased motion relative to the uninvolved side and is indicative of a sprain of the distal tibiofibular syndesmosis or the subtalar joint

24
Q

what are some indications for syndesmosis repair?

A
  • greater than 3-4 mm of lateral displacement of fibula from tibia durign cotton’s test (done after fixation of lateral malleolus)
  • fx located 3.5-4 cm proximal to ankle mortise along with a emdial injury
  • tib-fib overlap less than 6 mm on AP x-ray and less than 1 mm on ankle mortise x-ray
25
Q

Pankovich, Wagstaff-LeFort fractures 1979

A

fibular avulsion fractures

  • type I: avulsion fx maintaining attachment to both ATF and AITFL
  • type II: avulsion fx associated with an oblique fx of fibula originating distal to AITFL, spiral fx of fibula with proximal fibular spike and a trnsverse fx associated with avulsion fragment
  • type III: avulsion fx of anterior tibial tubercle followed by a type II
26
Q

classification of Volkmans fractures

A
  • type A: large intra-articular fx (greater than 25%) with displacement
  • type B: small intra-articular fracture (less than 25% of surface area) with impaction
  • type C: small fracture with minimal impaction and articular damage
  • type D: avulsion of the PITFL w/o articular involvement
27
Q

medial mallelolar fracture - muller

A

type A: avulsion of the tip of medial malleolus of horizontal orientation

type B: avulsion fracture at the level of the ankle joint in a horizontal orientation

type C: oblique fracture

Type D: vertical fracture

28
Q

leach ankle sprain classification

A
  • 1st degree: rupture of ATF
  • 2nd degree: rupture of ATF and CF
  • 3rd degree: rupture of ATF, CF, and PTF
29
Q

O’Donoghue 1958 ankle sprain classification

A
  • grade I: partial tear, mild tenderness and swelling but no loss of function or instability
  • grade II: incomplete tear, moderate pain and swelling with ecchymosis, some loss of functiona nd moderate instability
  • grade III: complete tear, sever pain, swelling and ecchymosis, unable to bear weight and severe instability
30
Q

Dias ankle sprain classification 1979

A
  • grade I: partial rupture of CFL
  • grade II: rupture of ATF
  • grade III: complete rupture of CFL, ATF, and/or PTF
  • grade IV: rupture of all lateral collateral ligaments and partial failure of deltoid ligament
31
Q

buckingham classification

A

STJ dislocations

  • type I: medial STJ dislocation (FF goes medially and talar head moves laterally)
  • type II: lateral STJ dislocation
  • type III: anteiror and posterior STJ dislocation
32
Q

when do you need to fixate physeal plate trauma?

A

greater than 3 mm displacement

33
Q
A

Questions (13 decks)

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