Fracture Description &
Classification
Regions Emergency Medicine
Anatomic description of fractures
Type
 Comminution
 Location
 Displacement

Anatomic description - Type

Type is the overall
fracture pattern
 Examples are:
– Simple
– Spiral
– segmental
Anatomic description Communition
Comminution is the measure of the
number of pieces of broken bone that
there are.
 Examples are: non-comminuted or
mildly comminuted or severely
comminuted

Anatomic description - Location
Location is the anatomic location of the
fracture usually described by giving the
bone involved and location on the bone
 Examples are: distal radial shaft,
proximal 1/3 humeral shaft, intraarticular distal tibial

Anatomic description Displacement
Displacement is the amount the pieces
of a fracture have moved from their
normal location
 Can be displaced or non-displaced
 Subdivided into 3 sub-categories:
translation, angulation, and shortening

Displacement - Translation

Translation is
sideways motion of
the fracture - usually
described as a
percentage of
movement when
compared to the
diameter of the
bone.
Displacement - Angulation

Angulation is the
amount of bend at a
fracture described in
degrees.
Described with
respect to the apex
of the angle or with
respect to direction
of distal fragment.
Displacement - Shortening

Shortening is the
amount a fracture is
collapsed expressed
in centimeters.
Sometimes called
bayonette
apposition.
Anatomic description?
Anatomic description

Simple, transverse,
non-communited
midshaft radial and
ulnar fracture with
30 degrees apex
radial angulation.
Anatomic description??
Anatomic description

Simple, transverse,
non-communited
distal radial and
ulnar fracture with
100% radial
translation, 45
degrees apex ulnar
angulation and 2 cm
of shortening.
Why classify fractures?

Classification or description of fractures
is only used when the classification or
description is useful in providing
treatment or outcomes
Types of classifications
Anatomic description
 AO classification
 Salter-Harris classification
 Gustillo open fracture classification
 Fracture specific classifications

AO Classification
AO Classification
1st number = long bone
 2nd number = bone segment
 Letter = fracture type (A,B,C)
 Then 3rd & 4th numbers classify fracture group
& subgroup

Salter-Harris Classification
Only used for pediatric fractures that
involve the growth plate (physis)
 Five types (I-V)

Salter-Harris type I fracture

Type I fracture is
when there is a
fracture across the
physis with no
metaphysial or
epiphysial injury
Salter-Harris type II fracture

Type II fracture is
when there is a
fracture across the
physis which
extends into the
metaphysis
Salter-Harris type III fracture

Type III fracture is
when there is a
fracture across the
physis which
extends into the
epiphysis
Salter-Harris type IV fracture

Type IV fracture is
when there is a
fracture through
metaphysis, physis,
and epiphysis
Salter-Harris type V fracture

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

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

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
26-28 weeks

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

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
30-35 weeks

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

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