Classification of fractureClassification of the extent and type of fracture and its

associated soft tissue injuries allows determination of the best treatment.

Analysis of the fracture pattern reveals :• amount of energy imparted to the extremity• the stability of the fracture after reduction

• alerts the surgeon to higher-risk patterns of injury• to monitor results and to compare treatment results

with those of other surgeons and investigators• provides a basis for the evaluation of new treatment

methods

• The Orthopaedic Trauma Association (OTA) classification correlates the coding of the fracture with the expanded ICD-9 codes for diagnosis and treatment

• The AO classification by Muller et al. is based on the morphological characteristics and the location of the fracture.

• Taylor and Martin proposed a classification of metaphyseal fractures in which the main fracture is characterized as stable (S), unstable (U), or with diaphyseal extension (D).

Taylor and Martin divided into three subtypes :0. Extraarticular1. Less than 2 mm of displacement2. More than 2 mm of displacement

• With progression from type S to type D, treatment shifts toward external fixation and away from open reduction

• Conversely, with progression from subgroup 0 to subgroup 2, open reduction is indicated

Classification of Soft Tissue Injuries

Gustilo and Anderson in 1976 described their treatment of 1025 open fractures with

application of a grading system that offered prognostic information about the outcome of

infected fractures.In 1984 this system was modified and their

results updated.

The modified classification ( by Gustilo and Anderson ) is based on : the size of the wound

periosteal soft tissue damage periosteal stripping

vascular injury

Gustilo and Anderson Classification• Type I : have a clean wound less than 1 cm long• Type II : wound more than 1 cm long without

extensive soft tissue damage, skin flap or avulsi• Type III A : have extensive soft tissue lacerations or

flaps but maintain adequate soft tissue coverage of bone, or they result from high-energy trauma regardless of the size of the wound. This group includes segmental or severely comminuted fractures, even those with 1 cm lacerations

Gustilo and Anderson Classification

• Type III B : have extensive soft tissue loss with periosteal stripping and bony exposure. They usually are massively contaminated

• Type III C : open fractures with an arterial injury that requires repair regardless of the size of the soft tissue wound

• Other classifications include that of Tscherne and Gotzen. Closed fractures are divided into grades 0 through 3 and open fractures are divided into grades 1 through 4. This system includes soft tissue damage and compartment syndrome

• The AO-ASIF group added to their extensive fracture classification a soft tissue classification scheme that closely follows that of Tscherne and Gotzen includes both closed and open injuries, muscle-tendon injury and neurovascular injury

A number of other trauma scoring systems have been proposed, including :• Trauma Score (TS),

• Revised Trauma Score (RTS), • Injury severity Score (ISS),

• Modified Abbreviated Injury Severity Scale (MISS),

• Pediatric Trauma Score (PTS), • Nerve injury, Ischemia, Soft tissue Injury,

Skeletal Injury, Shock and Age of Patient Score (NISSSA)

• Hanover Fracture Scale-97 (HFS-97)