Classifications Flashcards
Classification for Achilles Tendon Rupture
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
Classification Non-insertional achilles tendonitis
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.
Classification for radiopaque lesions of achilles tendon
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.
Classification Peroneal Subluxation
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
Classification of longitudinal tears of peroneus brevis
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
fracture stability - Charnley 1974
- stable = transverse fractures
- unstable = long oblique fractures and comminuted
- potentially stable = short oblique fractures orientated less than 45 degrees from transverse axis
according to charney 1974, any fracture of the metatarsal shaft is …
unstable
Gustillo and Anderson open fracture classification 1976
- 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
Ruedi and Allgower Classification 1979
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
what type of lauge-hansen MOI would create pilon fracture?
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
AO classification of pilon fractures
- 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
Destot Classification
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
Kellam and Waddell 1979
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
Malle and Seligson 1980
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
Ovadia and Beals 1986
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
Mast classification 1988
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
staged protocol pilon fx fixation
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
Lauge Hansen Ankle Fracture Classification
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
what level of anatomy is used to define danis-weber classifications?
syndesmosis
Danis-weber classification 1980
- 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)
when is non-op treatment indicated for ankle fx?
isolated fibular fx with less than 2 mm displacement and no tenderness of medial malleolus (deltoid)
tx = short leg cast WB 6 wks
when should a posterior malleolar fracture be fixated with ORIF?
- If less than 30% articular area = vassal’s principles
- if greater than 30% articular area = ORIF with anterior approach and 1/2 cannulated screws
what is cotton’s test?
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
what are some indications for syndesmosis repair?
- 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
