FRACTURE CLASSIFICATION AND

EPONYM FRACTURES

Supervisor: Dr Syarifah
• Classification of fractures is of utmost
importance:
• severity and mechanics of injury that occurred
• types of fractures
• the site of the injury
• formulate most suitable treatment
Classification of fractures based on
• Open/Closed Fracture
• Gustilo-Anderson Classification
• Tscherne classification of Soft tissue injuries
• Anatomical Description
• Type of fractures
• Location
• Fracture Morphology
• Displacement
• AO Classification
• Fracture Specific Classification
 Tscherne classification of Soft Tissue Injuries

Tscherne 0 Tscherne 1
• Minimal soft tissue damage • Superficial abrasion or contusion
• indirect injury to limb (torsion) • mild fracture pattern
• simple fracture pattern
Tscherne 2
• Deep abrasion
• skin or muscle contusion
• severe fracture pattern
• direct trauma to limb
Tscherne 3
• Extensive skin contusion or crush injury
• severe damage to underlying muscle
• compartment syndrome
• subcutaneous avulsion
ANATOMICAL RELATION
 Anatomical Description
• Type of fractures:
• Complete
• complete loss of bony continuity, allowing overriding
and deformation
• Incomplete
• a bone has not completely lost continuity; some
portion of the bone remains intact
 Oblique Fracture

Transverse Fracture Spiral Fracture

Segmental Fracture

Comminuted Fracture

Fracture morphology
Impacted Fracture: Compression Fracture:
loss in continuity in the structure of when cancellous bone is
bones, at least one bone (or fragment of compressed by force(s) greater
bone) has been driven into anothe than the bone can withstand
 Incomplete Fracture

Greenstick Fracture Hairline Fracture

• Anatomical Location
• Displacement of Fracture
• Position of fracture fragments to one another
AO CLASSIFICATION
 AO Classification
• The AO group has developed
a comprehensive classification of fractures.
Arranged in order of increasing severity
according to
• the complexities of the fracture
• difficulty of treatment
• worsening prognosis.
• Using the AO/OTA system
• Which bone? (e.g Femur – 3)
• Which segment? (e.g Diaphysis – 2)
• Which type? (e.g Simple – A)
• Which group? (e.g Transverse - 3)
• Using the above example, the fracture is coded as
– 32-A3 (Simple tranverse diaphyseal femoral
fracture).
FRACTURE SPECIFIC
CLASSIFICATION OR EPONYM
 Gartland Classification of
Supracondylar humeral fracture
• Fall on outstretched hand
• P/w: pain refusal to move
elbow
• Associated with:
• AIN neuropraxia (most
commonly seen)
• Unable to flex IPJ of thumb
and DIPJ of index finger
• Radial nerve palsy
• Vascular injury
Undisplaced Angulated fracture with Displaced, no cortical
intact posterior cortex contact
Tear Drop Sign
 Hill-Sachs Fracture/Lesions
• posterolateral humeral head compression fracture, typically
secondary to recurrent anterior shoulder dislocations

Bankart Lesion
 Galeazzi fracture-dislocation
• fracture of the distal third
of the radius with
dislocation of distal
radioulnar joint and an
intact ulna
• due to a fall on an
outstretched hand with
the elbow in flexion.
• type I: dorsal displacement
(in pronation)
• type II: volar displacement
(in supination)
 Monteggia fracture-dislocation
• fracture of the proximal third or shaft of ulnar
with concomitant dislocation of the radial head
• Fall on an outstretched hand with the forearm in
excessive pronation (hyper-pronation injury
• Associated with:
• Terrible triad of elbow
• PIN neuropathy
• radial deviation of hand with wrist
extension
• weakness of thumb extension
• weakness of MCP extension
• most likely nerve injury
 Bado Classification

Type 1 Fracture of the proximal or middle

third of the ulna with anterior
dislocation of the radial head

Type 2 Fracture of the proximal or middle

third of the ulna with posterior
dislocation of the radial head
Type 3 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
• Radial head dislocation
 Colles, Smith, Barton’s Fracture
Colles’ Fracture
•fracture of the distal radial
metaphyseal region with
dorsal angulation and
impaction
•without the involvement
of the articular surface
•as the result of a fall onto
an outstretched hand
Smith's Fracture Barton's Fracture
•fractures of the •fractures of the distal
distal radius with volar radius extend through the
angulation of the distal articular surface
fracture fragment.
•a fall onto a flexed wrist or •fall upon an
direct blow to the back of outstretched arm,
the wrist leading to dorsiflexion
stress
 Smith’s fracture

Colles’ Fracture
Volar Barton

Dorsal Barton
 Die-punch fracture
• Intra-articular fracture of the distal radius with
impaction of the dorsal aspect of the lunate fossa
• results from axial loading forces on the distal radius.
 Chauffeur fractures
• intra-articular fractures of
the radial styloid process.
• direct trauma typically a
blow to the back of the
wrist or from forced
dorsiflexion and abduction.
 Boxer’s Fracture
• minimally comminuted,
transverse fractures of the 5th
• impaction injury (axial loading
of the 5th metacarpal) as a
consequence of a direct blow
with a clenched fist against a
solid surface.
 Bennett fracture & Rolando’s Fracture
Bennett Fracture Rolando fracture

• an intra-articular two-part • three-part or

fracture of the base of the comminuted intra-
first metacarpal bone. articular fracture-
• resulting from forced dislocation of the base of
abduction of the the thumb (proximal first
first metacarpal metacarpal)
• usually an axial blow to a
partially flexed
metacarpal, such as a
fistfight
 Rolando’s Fracture
Bennett’s Fracture
 Pipkin Classification
• Femoral head fracture (Uncommon however
commonly associated with hip dislocation)
• Mechanism
• impaction, avulsion or shear forces (dashboard
injury)
• falls from height
• sports injury
• industrial accidents
• Associated with:
• femoral neck fracture
• acetabular fracture
• sciatic nerve neuropraxia
• femoral head AVN
• ipsilateral knee ligamentous instability
Type I Inferior to the fovea

Type II Fracture fragments

include fovea
Type III Type I or type II +
NOF #
Type IV Any pattern of
femoral head
fracture +
acetabular fracture
Pipkin Type IV
 Garden Classification
• classification of femoral neck fractures
• predicts the development of AVN
• described particular femoral neck and acetabular trabeculae
patterns
• Associated with femoral shaft fractures
• mechanism
• high energy in young patients
• low energy falls in older patients
• Symptoms: slight pain in the groin or pain referred along the
medial side of the thigh and knee
• Physical exam:
• impacted and stress fractures
• no obvious clinical deformity
• pain with percussion over greater trochanter
• displaced fractures
• leg in external rotation and abduction, with shortening
undisplaced undisplaced complete fracture, complete fracture,
incomplete, includi complete incompletely completely
ng valgus impacted displaced displaced
fractures
 Winquist Classification
• based on midshaft femur fracture comminution
• is used with regards to management decision making 
whether a fracture requires an intramedullary nail or open
reduction.
• traumatic
• high-energy
• most common in younger population
• often a result of high-speed motor vehicle accidents
• low-energy
• more common in elderly, often a result of a fall from
standing
• Associated with ipsilateral femoral neck fracture
• Presentation:
• Pain at thigh
• affected leg often shortened
• tenderness about thigh

I Tiny Cortical fragment

II Butterfly fragment,
>50% cortical contact
with main fragment
III Butterfly fragment
involves >50%
IV Segmental fracture
 Schatzker Classification
• Tibial Plateau Fractures
• varus/valgus load with or without axial load
• high energy
• frequently associated with soft tissue injuries
• low energy
• usually insufficiency fractures
• Associated with
• meniscal tears
• ACL injuries
• compartment syndrome
• vascular injury
• Physical examinspection
• look circumferentially to rule-out an open injury
• palpation
• consider compartment syndrome when
compartments are firm and not compressible
• varus/valgus stress testing
• neurovascular exam
Schatzker 1 Schatzker 2 Schatzker 3
Lateral split fracture Type 1 + focal depression Focal depression
Type IV Type V Type VI
Medial plateau fracture Bicondylar fracture Metaphyseal-diaphyseal disassociation
 Danis-Weber Classification
• Classification of lateral malleolar fractures,
relating to level of the fracture in relation to
the ankle joint
• Mechanism: history of twisting injury, with
ankle going into inversion
• p/w:
• intense pain post injury and instability
• Swollen ankle and deformity
Type A Type B Type C
Fibular fracture below the Fracture at the syndemosis, Fibular fracture above the
syndemosis often associated with syndemosis, tibiofibular
disruption of the AFTL/ ligamen must be torn
disruption of medial
ligament (forced supination
and External rotation)
 Salter Harris Classification
• fractures through a growth plate
• are categorized according to the involvement
of the physis, metaphysis, and epiphysis.
• affects patient treatment and provides clues
to possible long-term complications
Type I

Type II
Type III
Type IV

Type V
 References
• Apley & Solomon's System of Orthopaedics
and Trauma 10th Edition
• AO/OTA Fracture and Dislocation Classification
Compendium—2018
• Fracture Classifications in Clinical Practice 2nd
Edition, Seyed Behrooz Mostofi
• Radiopedia