Fracture Classification

Question 1

Define FRACTURE.

Answer 1

A break on one cortex of a bone within a soft tissue envelope which exits from the opposite cortex.

Question 2

What are the 4 types of fractures, and their mechanism?

Answer 2

1) Spiral - twisting (long fracture line)
2) Oblique - twisting (short fracture line)
3) Transverse - bending (with bending wedge if third smaller fragment present)
4) Comminuted - high energy force

Question 3

Why is a comminuted fracture hopeless? and how is it managed?

Answer 3

Comminuted fracture -> no periosteum, no tissue attachment, no blood supply -> dead bone -> prone to infection

MANAGEMENT

• Bone removal
• Bone graft (if possible)

Question 4

How to read an X-Ray:

Answer 4

1) Name, DOB, Hospital number -> confirm with wristband
2) Date and time of Xray

3) Type of Xray, and side of Xray
- “This is an AP X-Ray examination of the left humerus”

4) Adequacy and Alignment
- “This X-Ray is of acceptable quality”, “too light/dark”, “the film is rotated”, “whole bone length is shown” (if foot, standing or weight-bearing X-Ray?)

5) Bone
- which bone
- where in bone (epiphysis, metaphysis, diaphysis)
- simple or comminuted?
- fracture pattern (transverse, oblique, spiral)
- displacement extent (“minimal displacement”, “bone has translated full cortex”, “angulation”, “shortening”, “rotation”)
- likely mechanism, and force degree

6) Joint involvement?
- “intraarticular/extraarticular”

7) Soft tissue
- air (open fracture)
- foreign material
- swelling/joint fluid (haemarthrosis or rlipohaemarthrosis)

See slide 30 and 31

Question 5

Why are all pelvic fractures bad?

Answer 5

Pelvic fractures are associated with enormous tissue damage (including organs, and blood vessels)

Question 6

What is the purpose of the AO classification, and what is it?

Answer 6

PURPOSE:

• fixing is more effective than plastering
• Plastering not ideal for long-term healing -> muscle wasting and joint stiffness

WHAT

1) Common bone fractures (8)
- Humerus
- Forearm
- Femur
- Tibia
- Spine
- Pelvis
- Hand
- Foot

2) Where on bone (3)
- Proximal
- Midshaft
- Distal

3) Type of fracture
4) Near joint?

Question 7

Give examples of soft tissues in the MSK.

Answer 7

1) Skin
2) Muscle
3) Fascia
4) Tendons and ligaments
5) Nerves
6) Blood vessels

Question 8

What are the angulations of the lower limb?

Answer 8

1) Valgus
- apex of joint medial
- distal limb away from midline

2) Varus
- apex of joint lateral
- distal limb towards midline

Question 9

Classification of ANKLE FRACTURES

Answer 9

• Webers classification
• AO classification

WEBERS - based on level of fibula fracture

1) Below syndesmosis -> plaster or splint
2) At syndesmosis -> ankle mortise might shift -> if stiff -> op
3) Above syndesmosis -> ankle mortise disrupted, ligaments and capsule ripped -> op

Question 10

Types of FEMORAL NECK FRACTURES, and their blood supplies in fracture.

Answer 10

1) Sub capital/ intracapsular * - within capsule -> blood supply interrupted
2) Intertrochanteric/ per trochanteric * - from greater to lesser trochanter -> blood supply not fully disrupted
3) Sub trochanteric

Question 11

Classification of INTERTROCHANTERIC / PER TROCHANTERIC FRACTURES, and its management.

Answer 11

• Evans classification
• AO classification

MANAGEMENT
- reduce and fix with DHS for all ages

Question 12

Classification of SUB CAPITAL / INTRACAPSULAR FRACTURES.

Answer 12

• Garden classification
• AO classification

GARDEN CLASSIFICATION

• Grade I -> undisplaced -> reduce and fix
• Grade II -> minimally displaced -> reduce and fix
• Grade III -> displaced -> replace femoral head
• Grade IV -> displaced -> replace femoral head

Question 13

Describe the blood supply to the femoral neck.

Answer 13

deep femoral artery -> medial and lateral circumflex femoral arteries -> retinacular vessels (in neck) -> arteries in ligamentum teres (in head)

Question 14

How are SUB CAPITAL / INTRACAPSULAR fractures managed in children vs. adults?

Answer 14

CHILDREN

• emergency -> op within 6hrs
• reduce carefully and anatomically (i.e. perfectly)
• alternatively, open reduction performed
• risk: avascular necrosis -> total hip replacement

ELDERLY

• Grade I and II -> reduce and fix
• Grade III and IV -> replace
• healthy and fit -> total hip replacement
• otherwise -> hemiarthroplasty

Question 15

Classification of PAEDIATRIC EPIPHYSEAL FRACTURES.

Answer 15

• SALTeR- harris classification

Straight 
Above 
beLow
Through 
cRushed