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Classifications > Trauma Classifications > Flashcards

Trauma Classifications Flashcards

1
Q

Gustillo

A

Type I Limited periosteal stripping, wound < 1 cm

Type II Mild to moderate periosteal stripping, wound 1-10 cm in length

Type IIIA Significant soft tissue injury (often evidenced by a segmental fracture or comminution), significant periosteal stripping, no flap required

Type IIIB Significant periosteal stripping and soft tissue injury, flap required due to inadequate soft tissue coverage (STSG doesn’t count). Treat proximal 1/3 fxs with gastrocnemius rotation flap, middle 1/3 fxs with soleus rotation flap, distal 1/3 fxs with free flap.

Type IIIC Significant soft tissue injury (often evidenced by a segmental fracture or comminution), vascular injury requiring repair to maintain limb viability

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2
Q

Lauge Hansen

A
  1. SER
  2. PER
  3. SAD
  4. Pronation abduction
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3
Q

Diaphyseal Femur

A

Winquist or OTA
A) Simple
B) Wedge
C) Complex

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4
Q

Letournel

A 
Simple
Posterior Wall 
PC
Anterior Wall
AC
Transverse
Associated
AC/W PHT
ABC
Transverse and PW
PW/PC
T Type
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5
Q

Pelvic Ring - APC

A

APC
APC I Symphysis widening < 2.5 cm Non-operative. Protected weight bearing

APC II Symphysis widening > 2.5 cm. Anterior SI joint diastasis . Posterior SI ligaments intact. Disruption of sacrospinous and sacrotuberous ligaments. Anterior symphyseal plate or external fixator +/- posterior fixation

APC III Disruption of anterior and posterior SI ligaments (SI dislocation). Disruption of sacrospinous and sacrotuberous ligaments.
APCIII associated with vascular injury q q Anterior symphyseal multi-hole plateor external fixator and posterior stabilization with SI screws or plate/screws

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6
Q

Pelvic Ring - LC

A

LC Type I Oblique or transverse ramus fracture and ipsilateral anterior sacral ala compression fracture.

Non-operative. Protected weight bearing (complete, comminuted sacral component. Weight bearing as tolerated (simple, incomplete sacral fracture).

LC Type II Rami fracture and ipsilateral posterior ilium fracture dislocation (crescent fracture). Open reduction and internal fixation of ilium

LC Type III Ipsilateral lateral compression and contralateral APC (windswept pelvis).
Common mechanism is rollover vehicle accident or pedestrian vs auto.
Posterior stabilization with plate or SI screws as needed. Percutaneous or open based on injury pattern and surgeon preference.

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7
Q

Vertical Shear

A

Vertical shear Posterior and superior directed force.
Associated with the highest risk of hypovolemic shock (63%); mortality rate up to 25%
Posterior stabilization with plate or SI screws as needed. Percutaneous or open based on injury pattern and surgeon preference.

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8
Q

Schatzker

A 
Schatzker Classification
Type I	Lateral split fracture
 Type II	Split-depressed fracture 
  Type III	Pure depression fracture
 Type IV	Medial plateau fracture   	 
Type V	Bicondylar fracture
 Type VI	Metaphyseal-diaphyseal disassociation
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9
Q

Hemorrhagic Shock

A 
Class
% Blood Loss
HR
BP
Urine
pH
MS
Treatment
I	< 15% 
( 30 mL/hr	normal	anxious	Fluid
II	15% to 30% 
(750-1500ml)  	> 100 bpm	normal	20-30 mL/hr	normal	confused
irritable
combative	Fluid
III	30% to 40%
(1500-2000ml)	> 120 bpm	decreased	5-15 mL/hr	decreased	lethargic
irritable	Fluid & Blood
IV	> 40% (life threatening) 
(>2000ml)	> 140 bpm	decreased	negligible	decreased	lethargic
coma	Fluid & Blood
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10
Q

Pauwels

A

Type I < 30 deg from horizontal

Type II 30 to 50 deg from horizontal

Type III > 50 deg from horizontal (most unstable with highest risk of nonunion and AVN)

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11
Q

Calcaneus #

A

Sanders Classification
Type I • Nondisplaced posterior facet (regardless of number of fracture lines)

Type II • One fracture line in the posterior facet (two fragments)
Type III • Two fracture lines in the posterior facet (three fragments)
Type IV • Comminuted with more than three fracture lines in the posterior facet (four or more fragments)

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12
Q

Medial Clavicle Fracture

A

Anterior displacement

Most often non-operative
Rarely symptomatic
Nonoperative

Posterior displacement
Rare injury (2-3%)
Often physeal fracture-dislocation (age < 25)
Stability dependent on costoclavicular ligaments
Must assess airway and great vessel compromise
Serendipity radiographs and CT scan to evaluate
Surgical management with thoracic surgeon on standby

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13
Q

Midshaft Clavicle #

A

Nondisplaced
Less than 100% displacement
Nonoperative

Displaced
Greater than 100% displacement
Nonunion rate of 4.5%

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14
Q

Distal Clavicle #

A

Type I
Fracture occurs lateral to coracoclavicular ligaments (trapezoid, conoid) or interligamentous
Usually minimally displaced
Stable because conoid and trapezoid ligaments remain intact
Nonoperative

Type IIA
Fracture occurs medial to intact conoid and trapezoid ligament
Medial clavicle unstable
Up to 56% nonunion rate with nonoperative management
Operative

Type IIB
Fracture occurs either between ruptured conoid and intact trapezoid ligament or lateral to both ligaments torn
Medial clavicle unstable
Up to 30-45% nonunion rate with nonoperative management
Operative

Type III
Intraarticular fracture extending into AC joint
Conoid and trapezoid intact therefore stable injury
Patients may develop posttraumatic AC arthritis
Nonoperative

Type IV
A physeal fracture that occurs in the skeletally immature
Displacement of lateral clavicle occurs superiorly through a tear in the thick periosteum
Clavicle pulls out of periosteal sleeve
Conoid and trapezoid ligaments remain attached to periosteum and overall the fracture pattern is stable
Nonoperative

Type V	
Comminuted fracture
Conoid and trapezoid ligaments remain attached to comminuted fragment
Medial clavicle unstable
Operative
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15
Q

Pilon

A

OTA

  1. Extra articular
  2. Partial articular
  3. Complete articular
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16
Q

Talar Neck

A

Hawkins I Nondisplaced 0-13% AVN

Hawkins II Subtalar dislocation 20-50%

Hawkins III Subtalar and tibiotalar dislocation
20-100%

Hawkins IV
Subtalar, tibiotalar, and talonavicular dislocation
70-100%

17
Q

Radial Head #

A 
Mason classification
Type I	Minimally displaced fx, no mechanical block to rotation, intra-articular displacement 2mm or angulated, possible mechanical block to forearm rotation	
Type III	Comminuted and displaced fx, mechanical block to motion	
Type IV (Hotchkiss modification)	Radial head fx with elbow dislocation
18
Q

Distal Humerus

A

AO/OTA Classification of Distal Humerus Fractures
Type A Extraarticular (supracondylar fracture)
80% are extension type
Type B Intraarticular-Single column (partial articular-isolated condylar, coronal shear, epicondyle)

Type C Intraarticular-Both columns fractured and no portion of the joint contiguous with the shaft (complete articular)
Also Jupiter and Milch

19
Q

GCS

A 
Best Motor Response
6 - Obeys command
5 - Localizes pain
4 - Normal withdrawal (flexion)
3 - Abnormal withdrawal (flexion): decorticate
2 - Abnormal withdrawal (extension): decerebrate
1 - None (flaccid)
Best Verbal Response
5 - Oriented
4 - Confused conversation
3 - Inappropriate words
2 - Incomprehensible sounds
1 - None
Eye Opening
4 - Spontaneous
3 - To speech
2 - To pain
1 - None
20
Q

Osteomyelitis

A 
Anatomic Location
Stage I	Medullary	
Stage 2	Superficial	
Stage 3	Localized	
Stage 4	Diffuse

Host Type
Type A Normal
Type B Compromised
Type C Treatment is worse to patient than infection

21
Q

Capitellar #

A

Bryan and Morrey Classification (with McKee modification)
Type I Large osseous piece of the capitellum involved
Can involve trochlea
Type II Kocher-Lorenz fracture
Shear fracture of articular cartilage
Articular cartilage separation with very little subchondral bone attached
Type III Broberg-Morrey fracture
Severely comminuted
Multifragmentary
Type IV McKee modification
Coronal shear fracture that includes the capitellum and trochlea

22
Q

Monteggia #

A

Bado Classification
Type I Fracture of the proximal or middle third of the ulna with anterior dislocation of the radial head (most common in children and young adults)
Type II
Fracture of the proximal or middle third of the ulna with posterior dislocation of the radial head (70 to 80% of adult Monteggia fractures)
Type III Fracture of the ulnar metaphysis (distal to coronoid process) with lateral dislocation of the radial head
Type IV Fracture of the proximal or middle third of the ulna and radius with dislocation of the radial head in any direction

23
Q

Femoral Head Fractures

A

Pipkin Classification
Type I
Fx below fovea/ligamentum (small)
Does not involve the weightbearing portion of the femoral head
Type II Fx above fovea/ ligamentum (larger)
Involves the weightbearing portion of the femoral head
Type III Type I or II with associated femoral neck fx
High incidence of AVN
Type IV Type I or II with associated acetabular fx (usually posterior wall fracture)

Classifications (9 decks)

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