Fracture Classification - Orthopaedic Trauma - Lecture Slides, Slides of Orthopedics

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Fracture Classification

Why Classify?

• As a treatment guide
• To assist with prognosis
• To speak a common language with others in order to compare results

To Assist with Prognosis

• You can tell the patient what to expect with the results
• PROBLEM: Does not consider the soft tissues or other compounding factors

To Speak A Common Language

• This will allow results to be compared
• PROBLEM: Poor interobserver reliability with existing fracture classifications

Intraobserver Reliability

For a given fracture, each physician

should produce the same

classification

Literature

• 94 patients with ankle fractures
• 4 observers
• Classify according to Lauge Hansen and Weber
• Evaluated the precision (observer’s agreement with each other)

Thomsen et al, JBJS-Br, 1991

Literature

• 100 femoral neck fractures
• 8 observers
• Garden’s classification
  • Classified identical 22/
  • Disagreement b/t displaced and non- displaced in 45
  • Conclude poor ability to stage with this system

Frandsen, JBJS-B, 1988

Closed Fractures

• Fracture is not exposed to the environment
• All fractures have some degree of soft tissue

injury

• Commonly classified according to the

Tscherne classification

• Don’t underestimate the soft tissue injury as

this affects treatment and outcome!

Tscherne Classification

• Grade 0
  • Minimal soft tissue injury
  • Indirect injury
    • Grade 1
      • Injury from within
      • Superficial contusions or abrasions

Tscherne Classification

• Grade 2
• Direct injury
• More extensive soft tissue injury with muscle contusion, skin abrasions
• More severe bone injury (usually)

Literature

• Prospective study
• Tibial shaft fractures treated by intramedullary nail
• Open and closed
• 100 patients

Gaston, JBJS-B, 1999

Literature

What predicts outcome? Classifications used:

• AO
• Gustilo
• Tscherne
• Winquist-Hansen (comminution)

All x-rays reviewed by single physician Evaluated outcomes Union Additional surgery Infection Tscherne classification more predictive of outcome than others

Gaston, JBJS-B, 1999

Open Fractures

• Commonly described by the Gustilo system
• Model is tibia fractures
• Routinely applied to all types of open

fractures

• Gustilo emphasis on size of skin injury

Open Fractures

• Gustilo classification used for prognosis
• Fracture healing, infection and amputation rate correlate with the degree of soft tissue injury by Gustilo
• Fractures should be classified in the operating room at the time of initial debridement - Evaluate periosteal stripping - Consider soft tissue injury