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Classifications Flashcards

1
Q

Wilson-Katz Classification

A

Stress fractures

  • Type 1
  • Type 2
  • Type 3
  • Type 4
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2
Q

WK type 1

A

Type I: Fracture line with no evidence of endosteal callus or periosteal reaction
o Looks like a radiolucent line following injury due to osteoclastic activity
o Example: Jones fracture or any acute fracture (this is the only thing you will see in an acute injury on x-ray)

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3
Q

WK type 2

A
  • Type II: Focal sclerosis and endosteal callus
    o Radiopaque due to sclerosis
    o Cancellous bones will show this more than any other type of bone
    o You will see this at the base or the heads of the metatarsals
    o Also in the tarsal bones, calcaneus, metaphysis of the tibia
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4
Q

WK type 3

A
  • Type III: Periosteal reaction and external callus
    o Shaft of metatarsal is common site of periosteal reaction due to movement in the shaft of the metatarsal (more so than the ends which are locked in a joint)
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5
Q

WK type 4

A
  • Type IV: Mixed combination of above
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6
Q

Notes on WK classification

A

o X-ray will show sclerosis (W-K II) if fracture in cancellous bone (ends of metatarsal bones, tarsal bones, proximal and distal tibia and fibula)
o Microfracture of trabeculae is first event to occur and incites osteoblastic activity

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7
Q

Stewart Classification

A

5th Metatarsal Fractures

  • Type 1
  • Type 2
  • Type 3
  • Type 4
  • Type 5
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8
Q

Stewart type 1

A

True Jones fracture at the metaphysis of the 5th met base

Due to rotation of the forefoot with the base of the 5th met remaining fixed - NOT seen with inversion ankle sprains

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9
Q

Stewart type 2

A

Intra-articular fracture of the base of the 5th met

Results from contraction of the peroneus brevis

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10
Q

Stewart type 3

A

Avulsion of the 5th met base

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11
Q

Stewart type 4

A

Comminuted intra-articular fracture of the base of the 5th met

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12
Q

Stewart type 5

A

Partial avulsion fracture of the epiphysis (located in a longitudinal direction)

There is risk of Iselin’s AVN with thtis type of fracture

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13
Q

Torg Classification

A

Jones fracture classification

  • Type 1
  • Type 2
  • Type 3
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14
Q

Torg type 1

A

Acute Jones fracture

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15
Q

Torg type 2

A

Delayed union of a Jones fracture or diaphyseal stress fracture

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16
Q

Torg type 3

A

Non-union of a Jones fracture or a diaphyseal stress fracture

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17
Q

Oloff and Jacobs classification

A

Hallux limitus

  • Grade 1
  • Grade 2
  • Grade 3
  • Grade 4
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18
Q

Oloff and Jacobs grade 1

A

Pre-hallux limitus

  • Metatarsus primus elevatus, plantar subluxation of the proximal phalanx on the 1st met head and a pronatory component of the rearfoot
  • Pain with end ROM
  • Deformity is functional in nature with minimal adaptive changes
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19
Q

Oloff and Jacobs grade 2

A
  • Some flattening of the met head with a possible osteochondral defect
  • Pain on end ROM and structural adaptation has occurred
  • Passive ROM is limited but is most pronounced with forefoot loading
  • Small dorsal exostosis common
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20
Q

Oloff and Jacobs grade 3

A
  • More severe flattening of the met head, osteophytic production and large dorsal exostosis on both proximal phalanx and met head
  • Non-uniform joint space narrowing, crepitus
  • Pain on full ROM
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21
Q

Oloff and Jacobs grade 4

A

Grade 4

  • More severe form of grade 3 with obliteration of the joint space, loose bodies present in the joint space or capsule
  • <10 degrees of total MTPJ motion
  • May have associated inflammatory arthritis
  • May be asymptomatic if ankylosis has occurred
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22
Q

Johnson and Strom

A

Posterior Tibial Tendon Dysfunction (PTTD)

  • Stage 1
  • Stage 2
  • Stage 3
  • Stage 4

Categorized based on:

  • Condition of PTT
  • Deformity
  • Pain
  • Ability to do single limb heel rise
  • Too many toes sign
  • Valgus/arthritis
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23
Q

Johnson and Strom stage 1

A
  • Tenosynovitis, but no degeneration of PTT
  • Medial pain
  • Mild weakness on heel rise
  • Hindfoot inverts on heel rise
  • Negative too many toes sign
  • No valgus or arthritis
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24
Q

Johnson and Strom stage 2

A
  • Elongation and degeneration of PTT
  • Flexible, reducible pes planus
  • Pain medial, lateral or both
  • Moderate weakness on heel rise
  • Absent or little inversion on heel rise
  • Positive too many toes sign
  • No valgus or arthritis
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25
Q

Johnson and Strom stage 3

A
  • Elongation and degeneration of PTT
  • Fixed, non-reducible pes planus
  • Pain medial, lateral or both
  • Unable to do heel rise or no inversion with heel rise
  • Positive too many toes sign
  • No valgus or arthritis
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26
Q

Johnson and Strom stage 4

A
  • Elongation and degeneration of PTT
  • Fixed, non-reducible pes planus
  • Pain medial, lateral or both
  • Unable to do heel rise or no inversion with heel rise
  • Positive too many toes sign
  • YES - valgus or arthritis
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27
Q

Sedden classification

A

Nerve injuries

  • Neuropraxia
  • Axonotomesis
  • Neurotomesis
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28
Q

Neuropraxia

A

Interruption of the nerve impulse due to external nerve pressure resulting in pinpoint segmental demyelination

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29
Q

Axonotomesis

A

Severance of individual nerve fibers resulting in partial or complete severance of the nerve

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30
Q

Neurotomesis

A

Complete severance of the nerve resulting in Wallerian degeneration

NOTE: Wallerian degeneration is a process that results when a nerve fiber is cut or crushed and the part of the axon distal to the injury (i.e. farther from the neuron’s cell body) degenerates

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31
Q

Sunderland Classification

A

Nerve injuries

  • 1st degree
  • 2nd degree
  • 3rd degree
  • 4th degree
  • 5th degree
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32
Q

Sunderland 1st degree

A

Disruption of neurological impulses without Wallerian degeneration

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33
Q

Sunderland 2nd degree

A

Disruption of the axon with Wallerian degeneration distal to the point of trauma

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34
Q

Sunderland 3rd degree

A

Fibrous and obstruction of the nerve, regrowth with fusiform swelling

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35
Q

Sunderland 4th degree

A

Incomplete severance of the nerve

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36
Q

Sunderland 5th degree

A

Complete severance of the nerve

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37
Q

Hardcastle/Myerson Classification

A

Lisfranc fracture/dislocation

  • Type A (A1 and A2)
  • Type B (B1 and B2)
  • Type C (C1 and C2)
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38
Q

Hardcastle/Myerson type A (A1 and A2)

A

Total displacement

  • A1: lateral displacement
  • A2: dorsoplantar displacement
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39
Q

Hardcastle/Myerson type B (B1 and B2)

A

Partial displacement

  • B1: medial dislocation of 1st metatarsal
  • B2: lateral dislocation of lesser metatarsals
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40
Q

Hardcastle/Myerson type C (C1 and C2)

A

Divergent (1st met medial while lessers go lateral)

  • C1: 1st met displaces medially, some lesser mets laterally displace
  • C2: 1st met displaces medially, all lesser mets laterally displace
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41
Q

Quene and Kuss

A

Lisfranc fracture/dislocations

  • Homolateral
  • Isolateral
  • Divergent
42
Q

Homolateral

A

All 5 mets are displaced in the transverse plane

43
Q

Isolateral

A

1 or 2 mets are displaced in the transverse plane

44
Q

Divergent

A

Displacement is in both the sagittal and transverse plane

45
Q

Rowe Classification

A

Calcaneal fractures

  • Type I (A, B, C)
  • Type 2 (A, B)
  • Type 3
  • Type 4
  • Type 5
46
Q

Rowe type 1A

A

Fracture of the tuberosity

Due to inversion or eversion

47
Q

Rowe type 1B

A

Fracture of the sustentaculum tali

Due to twist on a supinated foot

48
Q

Rowe type 1C

A

Fracture of the anterior tubercle

Due to plantarflexion on a supinated foot

MOST COMMON TYPE (also most common in FEMALES)

49
Q

Rowe type 2A

A

Beak fracture without Achilles insertion involvement

50
Q

Rowe type 2B

A

Avulsion of the Achilles tendon

51
Q

Rowe type 3

A

Fracture of the body without STJ involvement

MOST COMMON extra-articular calcaneal fracture

52
Q

Rowe type 4

A

Fracture of the body with STJ involvement

53
Q

Rowe type 5

A

Comminution of the body of the calcaneus

54
Q

Essex Lopressti classification

A

Calcaneal fractures

  • Type 1 (tongue type)
  • Type 2 (joint depression type)
55
Q

Essex Lopressti type 1

A

Tongue type

  • 1st fracture line running superior to inferior
  • 2nd fracture line exiting the posterior aspect of the calcaneus
56
Q

Essex Lopressti type 2

A

Joint depression type

  • 1st fracture line running superior to inferior
  • 2nd fracture line surrounding the STJ
57
Q

Sanders classification

A

Calcaneal fractures (MUST use CT)

  • Type 1
  • Type 2
  • Type 3
  • Type 4

Modifiers are used which divide the posterior facet into 3 equal portions by lines A, B and C

  • A = lateral
  • B = middle
  • C = sustentaculum tali

Remember SC… Sanders CT and Sustentaculum C

58
Q

Sanders type 1

A

All non-displaced fractures no matter how many fragments

59
Q

Sanders type 2

A

2 part fracture of the posterior facet - fracture line is either A, B or C

60
Q

Sanders type 3

A

3 part fracture of the posterior facet - fracture line is combinations of AB, AC or BC

61
Q

Sanders type 4

A

4 part fracture with high degree of comminution

62
Q

Hanover classification

A

Calcaneal fractures
- CT scan evaluation based on fracments involved and number of joint fractures

5 fragments

  • Sustentaculum tali
  • Tuberosity
  • STJ
  • Anterior process
  • Anterior STJ fragment

Most common is the 5 fragment/2 joint surface

63
Q

Danis-Weber

A

Ankle fractures

  • A = fibular fracture below ankle joint
  • B = fibular fracture at ankle joint
  • C = fibular fracture above joint
64
Q

Lauge Hansen

A

Ankle fractures

  • Supination adduction (SAd)
  • Pronation abduction (PAb)
  • Supination external rotation (SER)
  • Pronation external rotation (PER)
65
Q

Supination adduction (SAd)

A

DW A - starts LATERAL

  • 1: rupture lateral collaterals or TRANSVERSE fibular fracture below ankle joint
  • 2: VERTICAL fracture of medial malleolus
66
Q

Pronation abduction (PAb)

A

DW B - starts MEDIAL

  • 1: rupture deltoid or TRANSVERSE medial malleolus fracture
  • 2: disruption of AITFL and PITFL, T-C fracture or Wagstaff fracture
  • 3: SHORT oblique/comminuted fracture of fibula at ankle joint
67
Q

Supination external rotation (SER)

A

DW B - starts ANTERIOR - MOST COMMON

  • 1: disruption of AITFL, T-C fracture or Wagstaff fracture
  • 2: SPIRAL fracture of fibula at ankle joint (posterior spike)
  • 3: disruption of PIFTF
  • 4: rupture deltoid or transverse medial malleolus fracture
68
Q

Pronation external rotation (PER)

A

DW C - starts MEDIAL

  • 1: rupture deltoid or TRANSVERSE medial malleolus fracture
  • 2: disruption of AITFL or rupture of interosseous membrane
  • 3: fibular fracture proximal to syndesmosis
  • 4: disruption of PITFL
69
Q

Meuller Classification

A 
Medial malleolar fractures 
o	A = Avulsion 
o	B = Transverse at level of mortise 
o	C = Oblique 
o	D = Near vertical
70
Q

Ottawa ankle rules

A

Developed by ER physicians to reduce unnecessary radiographs, order only if:
o Bony tenderness along distal 6 cm of tibia or fibula
o Bony tenderness at distal tip of tibia or fibula
o Bony tenderness at 5th metatarsal base
o Bony tenderness at navicular
o Inability to bear weight or walk 4 steps

71
Q

Volkman fracture

A

o Volkmann fracture: avulsion of PITFL off tibia&raquo_space; P tib

72
Q

Tilleaux-Chaput fracture

A

Tilleaux-Chaput fracture: avulsion of AITFL off tibia&raquo_space; A tib

73
Q

Wagstaff fracture

A

Wagstaff fracture: avulsion of AITFL off fibula&raquo_space; A fib

74
Q

Bosworth fracture

A

Bosworth fracture: avulsion of PITFL&raquo_space; P fib

75
Q

Maisonneuve fracture

A

Weber C type proximal fibular fracture within 10 cm of fibular neck

76
Q

Saltar Harris classification

A

Physeal plate trauma

  • Type 1 (S = slip)
  • Type 2 (A = above)
  • Type 3 (L = lower) AKA Tillaux fracture
  • Type 4 (T = through)
  • Type 5 (R = really bad, impaction resulting in comminution, halts growth)
77
Q

Hawkins classification

A

Talar neck fractures

  • Type 1
  • Type 2
  • Type 3
  • Type 4
78
Q

Hawkins type 1

A

Vertical fracture of the talar neck without displacement, disruption of 1 blood vessel

AVN risk 12%

79
Q

Hawkins type 2

A

Vertical fracture of talar neck with dislocation of the talar body from the STJ, disruption of 2 blood vessels

AVN risk 42%

80
Q

Hawkins type 3

A

Vertical fracture of the neck of the talus, dislocation of the STJ and ankle, disruption of 2 blood vessels

AVN risk 91%

81
Q

Hawkins type 4

A

Type 3 with addition of displacement of the TN joint and disruption of 3 blood vessels

AVN risk 95%

82
Q

Talar dome mechanism of injury

A

DIAL A PIMP

  • DIAL: anterior lateral lesion from dorsiflexion and inversion - WAFER shaped fragment
  • PIMP: posterior medial lesion from plantarflexion and inversion/external rotation- CUP shaped fragment
83
Q

Berndt Hardy

A

Talar dome fractures

  • Stage 1
  • Stage 2
  • Stage 3
  • Stage 4
84
Q

Berndt Hardy stage 1

A

Osteochondral compression of the talar dome

85
Q

Berndt Hardy stage 2

A

Partially detached, non-displaced osteochondral fracture

86
Q

Berndt Hardy stage 3

A

Completely detached, non-displaced osteochondral fracture

87
Q

Berndt Hardy stage 4

A

Displaced osteochondral fracture

88
Q

Gustillo and Anderson

A

Open fractures

  • Type 1
  • Type 2
  • Type 3 (A, B, C)
89
Q

Gustillo and Anderson Type 1

A

Open fracture with a wound <1 cm and clean

0-2% risk of infection

Antibiotics:
- Cefazolin 2 g IV initially, Cefazolin 1 g IV q8 hrs for 48-72 hrs

90
Q

Gustillo and Anderson Type 2

A

Open fracture with a laceration >1 cm without extensive soft tissue damage

2-7% risk of infection

Antibiotics:

  • Cefazolin 2 g IV initially, Cefazolin 1 g IV q8 hrs for 48-72 hrs
  • Gentamicin 1.5 mg/kg IV initially, Gentamicin3.5-5 mg/kg/day divided for q8 hrs for 48-72 hrs
91
Q

Gustillo and Anderson Type 3

A

Open fracture with extensive soft tissue damage (>5 cm wound)

A = adequate soft tissue coverage >> 7% risk of infection 
B = extensive soft tissue damage with periosteal stripping >> 50% risk of infection 
C = arterial injury requiring repair >> 25-50% risk of infection, 50% risk of amputation

Antibiotics:

  • Cefazolin 2 g IV initially, Cefazolin 1 g IV q8 hrs for 48-72 hrs
  • Gentamicin 1.5 mg/kg IV initially, Gentamicin3.5-5 mg/kg/day divided for q8 hrs for 48-72 hrs
  • SOIL CONTAMINATION/FARM INJURY: Add Penicillin for anaerobic coverage
92
Q

Eckert and Davis

A

Peroneal subluxation

  • Grade I
  • Grade II
  • Grade III
93
Q

Eckert and Davis grade 1

A

Retinaculum ruptures from the cartilaginous lip and lateral malleolus

94
Q

Eckert and Davis grade 2

A

Distal edge of fibrous lip is elevated with the retinaculum

95
Q

Eckert and Davis grade 3

A

Thin fragment of bone is avulsed from the deep surface of the Peroneal retinaculum and
deep fascia

96
Q

Kuwada classification

A

Achilles tendon rupture

  • Type 1
  • Type 2
  • Type 3
  • Type 4
97
Q

Kuwada type 1

A

Partial tear of <50%

98
Q

Kuwada type 2

A

Complete tear with defect after debridement <3 cm

99
Q

Kuwada type 3

A

Complete tear with defect after debridement 3-6 cm

100
Q

Kuwada type 4

A

Complete tear with defect after debridement >6 cm

101
Q

ADD

A
  • Wound classifications

- Accessory navicular

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