INDIAN VETERINARY RESEARCH INSTITUTE,

IZATNAGAR
CLASSIFICATION OF FRACTURE
FRACTURE HEALING
Dr Rekha Pathak and Prarthana R

Division of Veterinary Surgery & Radiology

IVRI
 FRACTURE
• Defination :
• Break in the continuity of bone with or without displacement of
fragment
• The type of fracture and degree of soft tissue involvement mainly
depend on :
• Cause of fracture
• Bone involvement
• The site of fracture
• Temperament of animal
• The time that lapsed between the infliction of the injury and treatment
given
• ETIOLOGY

1) Direct cause
I. Intrinsic causes
II. Extrinsic causes
2) Indirect cause
DIRECT CAUSE
• INTRINSIC CAUSE:

• These are related to either violent muscle contractions and local or systemic
disease
• Muscular contraction :

1. Violent contraction of muscle cause avulsion fracture

2. Avulsion fracture : eg – Acromion ,greater humeral tubercle ,

olecranon, Ischial tuberosity, trochanter major, cranial tibia tuberosity and
calcaneous bone.
• EXTRINSIC CAUSE :
• These causes are mainly related to various types of trauma and the
forces that may act on a bone
1. Direct violence : Trauma is the most common cause of fracture –
automobile injury , falling from a height

2. Indirect violence : Indirect trauma because of bending , torsional ,

compression and shearing force transmitted to a weak point within
the bone – running , jumping or falling of an animal
INDIRECT CAUSE

1. Fracture common in
– superficial position
- Shape
- Osseous structure
2. Smooth road and slippery floor
3. Disease condition of bone
4. Old age
CLASSIFICATION OF FRACTURE
• Simple
• Compound
• Complicated
• Incomplete
• Complete
• Avulsion
SIMPLE FRACTURE
• Does not communicate outside
• no wound on skin
COMPOUND FRACTURE
• Communicate with open wound
on skin
INCOMPLETE FRACTURE
• Does not extend through complete thickness of bone

1. Green stick
2. Partial or Splintered
3. Fissured
4. Deferred
 Green stick fracture

• It is characterized by partial loss of

continuity and displacement is minimal

• Part of the bone remain intact

• Green stick fracture

• Bone is partially broken like bent green

stick

• Young animals
FISSURED FRACTURE

• Fissure (crack) extending

through the bone without causing
any displacement of the
fragments
• Undisplaced fragments which
may displace at operation or
under stress
• Longitudinal, transverse or
oblique
DEFFERED FRACTURE

• Separation of fragments occur only after a varying period

after the incident

• Violence, strain or concussion

COMPLETE FRACTURE
• Bone is broken completely through its thickness

• Single
• Double
• Multiple
a)Single b)Double c) Communited
AVULSION FRACTURE
• Tearing of bony prominance (tuberosity) by forcible pull of its
tendinous or muscular attachments
COMPLICATED FRACTURE

• A closed fracture in which there is

considerable injury to important
neighboring vessels ,nerves or joint
involvement
• Accompanied by the opening of a
joint or visceral cavity
• Example : Complicated fracture of rib
Others
• Based on portion of bone involved-

1. Diphysary
2. Epiphysary
3. Supracondylar
4. Condylar
5. Transcondylar
6. Intercondylar
7. Articular
• Articular fracture

• Fracture involving subchondral bone

& articular cartilage
• Extra articular
• Not involving the joint surface
• Based on direcion of Fracture

1. Transverse
2. Longitudinal
3. Oblique
4. Spiral
• 1)Transverse fracture

• The fracture line is at right

angle to the long axis of bone

• Most caused by bending force

• 2)Oblique fracture

• The line of the fracture is

diagonal to the long axis of bone

• Caused by bending with axial

compression
• 3)Spiral fracture

• The fracture line is spiral along

the long axis of bone

• caused by torsional twisting or

rotational force
• 4)Comminuted fracture

• It comprises of at least three

fracture lines and all of them
meet at a common point

• Caused by high energy trauma

• 6)Avulsion fracture/
apophyseal

• A fragment of bone at the site of

muscle insertion is detached due
to its forceful contraction

• Pulled by tendon or ligament

Correction of Avulsion fracture
• Depending on relationship between fragments

1. Impacted
2. Distracted
3. Depressed
4. Over-riding
5. Compression
IMPACTED FRACTURE

• One end of broken bone is driven

into other end or one bone is
driven into the fracture site of
another
• Union is rapid but bone is
shortened
DISTRACTED FRACTURE
• A fracture resulting in increased overall bone length,is due
distraction of bone component
DEPRESSED FRACTURE
• The fragments are displaced and produce a cavity
• Especially part of the skull
a)Impacted c) Compression
b)Over riding
According to stability of fractured fragment

• Charnley classification

• Used to determine which fracture would respond to closed

reduction and reduction
1. Stable Fracture
2. Unstable Fracture
• 1) Stable after fracture :

• The fragments more or less interlock after reduction

• Maintain the approximate length of the segment

• Eg – simple fracture ; fractured pieces of bone are well aligned and

stable
• 2)Unstable fracture :

• Fracture in which fragments of the broken

bone are
• misaligned & displaced
• The fracture fragments are unstable after
reduction
• Fracture collapse as soon as reducing force
is removed
Epiphyseal fracture or growth plate fracture
• The most commonly used is the Salter- Harris system (salter &
Harris, 1963 )
• Fracture of epiphysis occurs in mature animal after closure of the
epiphyseal plate
• Type 1
• Complete , through the
hypertrophied cartilage cell zone

• Type 2
• Partially includes the metaphysis

• Type 3
• Intra articular fracture to the
hypertrophied zone and then along
the epiphyseal plate to the edge

Salter - Harris type I

 Salter- Harris type III fracture
• Type 4
• Intra articular fracture that traverses
the epiphysis , epiphyseal plate and
metaphysis

• Type 5
• Crushing injury that causes
destruction of growing cells

• Type 6
• New bone bridges the growth plate
SPECIAL JOINT FRACTURE

• Certain specific fractures have been

classified to aid prognosis and
treatment(importance in the racing
Greyhound)
• Accessory carpal bone
• Type 1 –
• Intra articular avulsion of the distal margin
• Type 2 –
• Intra articular fracture of the proximal
margin
 Type 3 –
• Extra articular avulsion of the
• distal margin
• Type 4 –
• Extra articular avulsion of the
insertion of flexor carpi ulnaris at
proximal palmer surface

• Type 5 – Comminuted fracture

of the body which may involve
the articular surface
• Central tarsal bone
• Type 1 –
• Small dorsal stab fracture with minimal
displacement
• Type 2 –
• Dorsal stab fracture with displacement
• Type 3 –
• One third to half of the bone fractured in
the median plane and displaced medially
or dorsally
• Type 4 –
• Combination of types 2 & 3

• Type 5 –
• Sever comminution
• Various combintions of fractures
of the tarsus have been described
as Triads ( Newton and
Nunamaker)
• A system for classification of the soft tissue injury ( muller et al.
1992)

• System is developed for humans

• System may be too complicated for animals – can be used with little
variation
• Integument closed (IC)
• IC1 No injury
• IC2 No laceration but contusion
• IC3 Circumscribed degloving
• IC4 Extensive closed degloving
• IC5 Necropsis from contusion
• Integument open (IO)
• IO1 Skin breakage from inside out
• IO2 Skin breakage from outside in > 5cm,devitalized edges
• IO3 Skin breakage from outside in < 5cm, devitalised edges,
• circumscribed degloving
• IO4 Full thickness contusion, abrasion, skin loss
• IO5 Extensive degloving
• Muscle tendon (MT)
• MT1 No injury
• MT 2 Circumscribed injury, one muscle group only
• MT3 Extensive injury, two or more muscle groups
• MT4 Avulsion or loss of entire muscle groups,
• tendon laceration
• MT5 Compartment syndrome/ crush syndrome
• Neurovascular (NV)
• NV1 No injury
• NV2 Isolated nerve injury
• NV3 Localized vascular injury
• NV 4 Combined neurovascular injury
• NV5 Subtotal / total amputation
• General classification of fractures was developed by by Muller and others of the
AO / ASIF group for human fractures .
• System using alphanumeric classifications combined with electronically stored X-
ray images
• AO - Arbeitsgemeinschaftn fur Osteosynthesefragen
• ASIF - Association for the study of internal fixation
• This has been modified to use in small animals and horse
Two systems for small animals
• 1) Prieur ( Prier et al., 1990)
• 2) Unger (unger et al., 1990)
• These fractures describes the bone , the location and the type of fracture

• Each of the proposed system creates a 4 digit record in a similar wat to the
human AO system

• The Prieur & Unger fracture classification system used only for long bones .

• Not involving the skull , vertebral coloumn , pelvis or small limb bones.

• Doesn’t involve soft tissue problems

• The prieur system
• This is simplest system – slightly less information

• Digits are allocated under each fields

• (Bone ; location ; fracture area ; fragment number )

• The location Zones of each bone are determined by drawing a square

around the ends , of length and width equal to the widest dimension of
the bone end
Field Number
•Bone Humerus 1
Radius & Ulna 2

Femur 3

Tibia 4
•Location Proximal segment 1
Middle segment 2

Distal Segment 3
•Fracture area( % of bone length )

< 5% (& or not involving articular cartilage) 1

5–25%(Specific fractures of femur neck) 2

> 25%(&/or involving articular surfaces) 3
•Number of fragments

Two 2
Example
• The unger system

• Simliar to Prieur system - Records more data by attempting to

identify reducible or non reducible wedges or the direction of the
fracture line.
• Charts of both letters and numbers for each bone and codes allocated
for various fractures
 Clinical Signs
• Pain
• Dysfunction
• Local trauma
• Abnormal posture
• Crepitus
 Diagnosis
• Based on history and clinical examination- Pain, Dysfunction , Local
trauma , Abnormal posture,Crepitus
• Radiography
• Bone scan
• Computed tomography scan(CT)
• Micro CT
• Magnetic resonance imaging (MRI)
• Positron emission tomography(PET)
 Treatment option for open fracture

K wire Intramedullary pin Interlocking nail

Orthopedic wire Screw & plate Plate rod

FRACTURE HEALING
• Indirect bone healing - callus formation present
• Direct bone healing- without callus formation

• Others-
• Intramembranous bone healing- (Mesenchyme---- Osteoblast)
• Trabecular bone healing
• Physeal bone healing
STAGES OF HEALING OF FRACTURE
• Formation of hematoma ( within 24 hours)
• Formation of soft callus (10-21 days)
• Formation of primary bone callus (21 days -6 weeks)
• Formation of secondary bone callus (6-8 weeks)
RADIOGRAPHIC VIEW
THANKYOU