Fracture Classification - Orthopaedic Trauma - Lecture Slides, Slides for Orthopedics. Acharya Nagarjuna University
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devaki21 December 2012

Fracture Classification - Orthopaedic Trauma - Lecture Slides, Slides for Orthopedics. Acharya Nagarjuna University

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Fracture Classification, Interobserver Reliability, Lauge Hansen and Weber, Garden Classification, Femoral Neck Fractures, Closed Fractures, Tscherne Classification, Superficial Contusions are some points from this lectu...
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Injuries to the Patella and Extensor Mechanism

Fracture Classification

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Why Classify?

• As a treatment guide • To assist with

prognosis • To speak a common

language with others in order to compare results

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As a Treatment Guide

• If the same bone is broken, the surgeon can use a standard treatment

• PROBLEM: fracture personality and variation with equipment and experience

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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

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To Speak A Common Language

• This will allow results to be compared

• PROBLEM: Poor interobserver reliability with existing fracture classifications

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Interobserver Reliability

Different physicians agree on the classification of a fracture for a

particular patient

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Intraobserver Reliability

For a given fracture, each physician should produce the same

classification

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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

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Literature

• Acceptable reliabilty with both systems

• Poor precision of staging, especialy PA injuries

• Recommend: classification systems should have reliability analysis before used

Thomsen et al, JBJS-Br, 1991

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Literature

• 100 femoral neck fractures

• 8 observers • Garden’s classification

• Classified identical 22/100

• Disagreement b/t displaced and non- displaced in 45

• Conclude poor ability to stage with this system

Frandsen, JBJS-B, 1988 Docsity.com

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!

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Closed Fracture Considerations

• The energy of the injury

• Degree of contamination

• Patient factors • Additional injuries

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Tscherne Classification

• Grade 0 – Minimal soft tissue

injury – Indirect injury

• Grade 1 – Injury from within – Superficial

contusions or abrasions

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Tscherne Classification

• Grade 2 • Direct injury • More extensive soft

tissue injury with muscle contusion, skin abrasions

• More severe bone injury (usually)

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Tscherne Classification

• Grade 3 – Severe injury to soft

tissues – -degloving with

destruction of subcutaneous tissue and muscle

– Can include a compartment syndrome, vascular injury

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Literature

• Prospective study • Tibial shaft fractures

treated by intramedullary nail

• Open and closed • 100 patients

Gaston, JBJS-B, 1999

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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 Docsity.com

Open Fractures

• A break in the skin and underlying soft tissue leading directing into or communicating with the fracture and its hematoma

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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

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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

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Type I Open Fractures

• Inside-out injury • Clean wound • Minimal soft tissue

damage • No significant

periosteal stripping

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Type II Open Fractures

• Moderate soft tissue damage

• Outside-in mechanism • Higher energy injury • Some necrotic muscle,

some periosteal stripping

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Type IIIA Open Fractures

• High energy • Outside-in injury • Extensive muscle

devitalization • Bone coverage with

existing soft tissue not problematic

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Type IIIB Open Fractures

• High energy • Outside in injury • Extensive muscle

devitalization • Requires a local flap or

free flap for bone coverage and soft tissue closure

• Periosteal stripping

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Type IIIC Open Fractures

• High energy • Increased risk of

amputation and infection

• Major vascular injury requiring repair

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