Fracture Classification

Radius, Distal Fractures

Classification
I II A B C III IV A B C D

Description
Non-articular, non-displaced Non-articular, displaced Reducible, stable Reducible,unstable Ireducible Articular, non-displaced Articular, displaced Reducible, stable Reducible, unstable Ireducible Complex

Fracture Colles
In 1813, Abraham Colles described the Colles fracture, which is reported to be the most common distal radial fracture. The injury is usually produced by a FOOSH mechanism with the wrist in dorsiflexion. The impact produces a transverse fracture in the distal 2-3 cm of the radius articular surface. The fracture is dorsally displaced and may be comminuted. The fracture pattern is often described as a silver or dinner fork deformity. The fracture fragments are usually impacted and comminuted along the dorsal aspect, and it can extend into the epiphysis to involve the distal radiocarpal joint or the distal radioulnar joint.

Fracture Colles
AO Classification of Colles Fractures
Type A Extra-articular B C C1 C2 C3 Partial-articular Complete-articular Simple articular and metaphyseal fracture Simple articular with complex metaphyseal fracture Complex articular and metaphyseal fracture Description

Fracture Colles
Frykman Classification of Colles Fractures
Type
I II III IV V VI

Radius
Extra-articular Extra-articular Intra-articular Intra-articular Intra-articular Intra-articular

Ulna
Absent Present Absent Present Absent Present

Radiocalpar
Absent Absent Present Present Absent Absent

Radioulnar
Absent Absent Absent Absent Present Present

VII
VIII

Intra-articular
Intra-articular

Absent
Present

Present
Present

Present
Present

Smith Fracture
A Smith fracture is usually called a reverse Colles fracture because the distal fragment is displaced volarly. It is often described as a garden-spade deformity. The ulnar head can be displaced dorsally

Type Description Most stable, extra-articular transverse distal radial I

II III

fracture with palmar and proximal displacement Barton type, palmar-lip fracture of the distal radius with dislocation of the carpus Unstable, oblique juxta-articular fracture of the distal radius and tilted palmar

Barton Fracture

John Rhea Barton characterized the Barton's fracture in 1838 (Wood, 1992). This fracture involves a dorsal rim injury of the distal portion of the radius. The volar Barton fracture is thought to occur with the same mechanism as the Smith fracture, with more force and loading on the wrist. The dorsal Barton fracture is caused by a fall on an extended and pronated wrist increasing carpal compression force on the dorsal rim. The salient feature is a subluxation of the wrist in this die-punch injury. This fracture involves either the palmar or dorsal radial rim, and the mechanism is intra-articular. By definition, this fracture has some degree of carpal displacement. The carpal displacement distinguishes it from a Colles or Smith fracture. The palmar variety is more common than the dorsal type (Wood, 1992) PA and lateral views of the wrist are a minimal examination, but a truelateral projection is needed to evaluate the degree of carpal subluxation. In 1992, Wood and Berquist suggested that trispiral tomograms or coronal and/or sagittal CT scans can be used to evaluate articular congruity of the distal radius. Barton fractures are classified as dorsal or palmar (always intraarticular), and they always involve carpal subluxation. Complications of Barton fractures are similar to those of Colles fractures.

Hutchinson, chauffeur or radial styloid fracture

The chauffeur's fracture derives its name from injuries acquired when automobiles were cranked and backfired. The force is described as direct axial compression of the scaphoid into the radial facet. The radial styloid is fractured with associated avulsion of the radial collateral ligament (Wood, 1992; Resnick, 2002). This fracture represents an avulsion related to the attachment sites of the radiocarpal ligaments or the radial collateral ligament. Scapholunate dissociation and lesser arc injuries of the wrist may be indicated by a fracture line on the radial articular surface between the scaphoid and lunate fossae. Chauffeur's fractures are classified as simple or comminuted radial styloid fractures and as displaced or nondisplaced fractures. These injuries show no evidence of carpal subluxation. Complications include scapholunate dislocation, osteoarthritis, and ligamentous damage

Galeazzi or Piedmont fracture

A Galeazzi fracture results from a FOOSH mechanism with the forearm hyperpronated or from a direct impact to the dorsal radial wrist. The radial diaphysis at the distal and middle third junction is fractured with associated subluxation of the distal radioulnar joint. On PA views, the radius is shortened, and the radioulnar joint is disrupted. Radioulnar distances greater than 2 mm are suggestive of ligamentous injury and or a tear of the TFC. On the lateral view, the distal radius is angulated either volarly (Meschan, 1985) or in radially as a result of the pull of the brachioradialis muscle with more than 3 mm of ulnar displacement (Wood, 1992). An associated ulnar styloid fracture may also be present. PA views may show a displaced radial and ulnar styloid. The lateral view may reveal the associated radioulnar dislocation that is occult on the AP view. Classification is based on the direction of displacement of the distal fracture fragment. Complications include radial malunion, nonunion, and persistent subluxation of the radioulnar joint (Wood, 1992).

Essex-Lopresti Fracture

The Essex-Lopresti fracture consists of a comminuted and displaced radial head fracture along with disruption of the distal radioulnar joint and interosseous membrane. The thickened ridge of the scaphoid and lunate facet dissipate the energy delivered to the wrist in a FOOSH injury and is thought to account for fractures that occur between the scaphoid and lunate facets of the radius. The fracture line originates at the junction of the scaphoid and lunate fossa on the radial articular surface and courses laterally in a transverse or oblique direction. The intra-articular distal radial fracture of the radial styloid is associated with an avulsion of the radial collateral ligament. Routine PA and true lateral views are obtained. On the PA view, overlap, widening, or incongruity of the radioulnar joint should be noted. Resnick notes that careful radiographic positioning and measurements are essential, as is transaxial CT or MRI, to assess the extent of displacement or subluxation of the radioulnar joint. Complications are similar to those of Colles fractures and include radioulnar joint instability and TFC damage.

Salter-Harris Classification
Only used for pediatric fractures that involve the growth plate (physis)

Type I fracture is when there is a fracture across the physis with no metaphysial or epiphysial injury

Salter-Harris Classification

Type II fracture is when there is a fracture across the physis which extends into the metaphysis

Salter-Harris Classification

Type III fracture is when there is a fracture across the physis which extends into the epiphysis

Salter-Harris Classification

Type IV fracture is when there is a fracture through metaphysis, physis, and epiphysis

Type V fracture is when there is a crush injury to the physis

Gustillo classification
The Gustillo classification is used to classify open fracture - ones in which the skin has been disrupted Three grades that try to quantify the amount of soft tissue damage associated with the fracture

Gustillo classification Open fractures - grade 1

wound less than 1 cm w/ minimal soft tissue injury wound bed is clean bone injury is simple w/ minimal comminution w/ IM nailing, average time to union is 21-28 weeks

Gustillo classification Open fractures - grade 2

wound is greater than 1 cm w/ moderate soft tissue injury wound bed is moderately contaminated fracture contains moderate comminution w/ IM nailing, average time to union is 2628 weeks

Gustillo classification Open fractures - grade 3A

wound greater than 10 cm w/ crushed tissue and contamination soft tissue coverage of bone is usually possible w/ IM nailing, average time to union is 30-35 weeks

Gustillo classification Open fractures - grade 3B

wound greater than 10 cm w/ crushed tissue and contamination soft tissue is inadequate and requires regional or free flap w/ IM nailing, average time to union is 3035 weeks

Gustillo classification Open fractures - grade 3C

is fracture in which there is a major vascular injury requiring repair for limb salvage fractures can be classified using the MESS in some cases it will be necessary to consider BKA following tibial fracture