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Classification of Fractures 
& 
Management of Compound 
Fractures 
By Kevin J Ambadan
CLASSIFICATION 
• Based on Relationship with the Environment 
• Based on Displacement 
• Based on Fracture Pattern 
• Base...
Classification Based on 
Relationship with Environment 
1. CLOSED {Simple} 
2. OPEN {Compound}
Open Fractures 
• A break in the skin 
and underlying soft 
tissue leading to a 
communicating 
fracture hematoma
Gustilo Classification 
• The Gustillo classification is used to classify open 
fractures. 
• Three grades that try to qua...
Grade 3A 
• Limited stripping of periosteum and soft tissue 
from bone. 
• Adequate soft tissue coverage for bone, 
tendon...
Type 3B 
• Extensive stripping of soft tissue and 
periosteum from bone. 
• Requires a local flap or free tissue transfer ...
Muller’s (AO/OTA) Classification 
• Each long bone has 3 segments 
Proximal, Diaphyseal and Distal 
• Diaphyseal Fractures...
Classification: Based on Displacement 
1. UNDISPLACED 
2. DISPLACED
Displacement - Translation 
• Translation is sideways 
motion of the fracture - 
usually described as a 
percentage of mov...
Displacement - Angulation 
• Angulation is the 
amount of bend at a 
fracture described in 
degrees. Described 
with respe...
Displacement - Shortening 
• Shortening is the 
amount a fracture is 
collapsed/ shifted 
proximally, expressed 
in centim...
Classification: Based on Pattern 
1. Transverse 
2. Oblique 
3. Spiral 
4. Comminuted 
5. Segmental 
6. Stellate
According to the Path of the # Line 
Transverse Fracture 
A fracture in which the # 
line is perpendicular to the 
long ax...
According to the Path of the # Line 
Spiral Fracture 
A severe form of oblique 
fracture in which the # plane 
rotates alo...
Anatomical Classification of Fractures 
Comminuted Fracture : 
The bone is broken into many 
fragments. 
Stellate Fracture...
Anatomical Classification of Fractures 
Impacted Fracture: 
This # where a vertical force 
drives the distal fragment of 
...
Anatomical Classification of Fractures 
Avulsion Fracture: 
A chip of bone is avulsed by the sudden and unexpected 
contra...
Anatomical Classification of Fractures 
Stress Fracture : 
• It is a fracture occurring at a site in the bone subject to 
...
Classification: Based on Etiology 
1. TRAUMATIC 
2. PATHOLOGICAL 
– Tumors 
– Bone cysts 
– Osteomyelitis 
– Osteoporosis ...
Salter-Harris Classification 
• Only used for pediatric fractures that involve 
the growth plate (physis)
Salter-Harris type I fracture 
• Type I fracture is 
when there is a 
fracture across the 
physis with no 
metaphysial or ...
Salter-Harris type II fracture 
• Type II fracture is 
when there is a 
fracture across the 
physis which extends 
into th...
Salter-Harris type III fracture 
• Type III fracture is 
when there is a 
fracture across the 
physis which extends 
into ...
Salter-Harris type IV fracture 
• Type IV fracture is 
when there is a 
fracture through 
metaphysis, physis, 
and epiphys...
Salter-Harris type V fracture 
• Type V fracture is 
when there is a crush 
injury to the physis
Treatment of Compound 
Fracture
Aim 
• To convert contaminated wound into clean wound 
• To convert the open # into a closed one. 
• To establish a union ...
4 Essentials of Treatment 
• Antibiotic Prophylaxis 
• Urgent Wound and Fracture Debridement 
• Stabilization of the Fract...
Sterility and Antibiotic Cover 
• In most cases, Co-amoxiclav or Cefuroxime (or 
Clindamycin in case of penicillin allergy...
• Grade 2 and 3A fractures, delayed closure 
after ‘second look’ is sometimes preferred 
• Grade 3B & C, delayed cover is ...
Debridement 
• Thorough irrigation of wound with copious 
amounts of NS to remove all foreign material 
in wound, followed...
• Principles observed during debridement: 
– Wound margin excision 
– Wound extension 
– Delivery of fracture 
– Removal o...
Fracture Stabilization 
• Important in reducing risk of infection and 
assisting recovery of soft tissues 
• Method of fix...
• Internal or external fixation may be 
appropriate depending on individual 
characteristics of fracture and wound. 
• If ...
Stabilization of Open Fractures 
METHODS 
1.PLASTER IMMOBILISATION 
2.PINS & PLASTER 
3.SKELETAL TRACTION 
4.EXTERNAL FIXA...
External Fixators 
Method of choice in most open fractures 
Advantages: 
• Easily applied 
• Good skeletal & soft tissue s...
Amputation 
Indications: 
• Vascular injury – no repair possible 
• Functional outcome better with prosthesis 
• Life savi...
Thank You
Classification of Fractures & Compound Fracture Managment
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Classification of Fractures & Compound Fracture Managment

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Different Classifications of Fractures
&
Brief Management of Compound (Open) Fractures

Publicado en: Salud y medicina
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Classification of Fractures & Compound Fracture Managment

  1. 1. Classification of Fractures & Management of Compound Fractures By Kevin J Ambadan
  2. 2. CLASSIFICATION • Based on Relationship with the Environment • Based on Displacement • Based on Fracture Pattern • Based on Etiology
  3. 3. Classification Based on Relationship with Environment 1. CLOSED {Simple} 2. OPEN {Compound}
  4. 4. Open Fractures • A break in the skin and underlying soft tissue leading to a communicating fracture hematoma
  5. 5. Gustilo Classification • The Gustillo classification is used to classify open fractures. • Three grades that try to quantify the amount of soft tissue damage associated with the fracture Grade 1 — <1cm wound, min soft t/s injury Grade 2 — >1cm wound, mod soft t/s inury Grade 3 — >10cm wound, severe muscle devitalization Subgrades A,B,C
  6. 6. Grade 3A • Limited stripping of periosteum and soft tissue from bone. • Adequate soft tissue coverage for bone, tendons and neurovascular bundle.
  7. 7. Type 3B • Extensive stripping of soft tissue and periosteum from bone. • Requires a local flap or free tissue transfer Type 3C • A major vascular injury requiring repair
  8. 8. Muller’s (AO/OTA) Classification • Each long bone has 3 segments Proximal, Diaphyseal and Distal • Diaphyseal Fractures: – Simple – Wedge – Complex • Proximal & Distal – Extra-Articular – Partial Articular – Complete Articular
  9. 9. Classification: Based on Displacement 1. UNDISPLACED 2. DISPLACED
  10. 10. Displacement - Translation • Translation is sideways motion of the fracture - usually described as a percentage of movement when compared to the diameter of the bone -- --- -------direction of distal fragment decides
  11. 11. Displacement - Angulation • Angulation is the amount of bend at a fracture described in degrees. Described with respect to the apex of the angle .
  12. 12. Displacement - Shortening • Shortening is the amount a fracture is collapsed/ shifted proximally, expressed in centimeters.
  13. 13. Classification: Based on Pattern 1. Transverse 2. Oblique 3. Spiral 4. Comminuted 5. Segmental 6. Stellate
  14. 14. According to the Path of the # Line Transverse Fracture A fracture in which the # line is perpendicular to the long axis of the bone . Oblique Fracture A fracture in which the # line is at oblique angle to the long axis of the bone.
  15. 15. According to the Path of the # Line Spiral Fracture A severe form of oblique fracture in which the # plane rotates along the long axis of the bone. These #s occur secondary to rotational force.
  16. 16. Anatomical Classification of Fractures Comminuted Fracture : The bone is broken into many fragments. Stellate Fracture: This # occurs in the flat bones of the skull and in the patella, where the fracture lines run in various directions from one point.
  17. 17. Anatomical Classification of Fractures Impacted Fracture: This # where a vertical force drives the distal fragment of the fracture into the proximal fragment. Depressed Fracture: This # occurs in the skull where a segment of bone gets depressed into the cranium.
  18. 18. Anatomical Classification of Fractures Avulsion Fracture: A chip of bone is avulsed by the sudden and unexpected contraction of a powerful muscle from its point of insertion, Examples 1. ASIS Avulsion 2. JONE’S 5th MT base Avulsion
  19. 19. Anatomical Classification of Fractures Stress Fracture : • It is a fracture occurring at a site in the bone subject to repeated minor stresses over a period of time. Birth Fracture: • It is a fracture in the new born children due to injury during birth
  20. 20. Classification: Based on Etiology 1. TRAUMATIC 2. PATHOLOGICAL – Tumors – Bone cysts – Osteomyelitis – Osteoporosis – Osteogenesis imperfecta – Rickets
  21. 21. Salter-Harris Classification • Only used for pediatric fractures that involve the growth plate (physis)
  22. 22. Salter-Harris type I fracture • Type I fracture is when there is a fracture across the physis with no metaphysial or epiphysial injury
  23. 23. Salter-Harris type II fracture • Type II fracture is when there is a fracture across the physis which extends into the metaphysis
  24. 24. Salter-Harris type III fracture • Type III fracture is when there is a fracture across the physis which extends into the epiphysis
  25. 25. Salter-Harris type IV fracture • Type IV fracture is when there is a fracture through metaphysis, physis, and epiphysis
  26. 26. Salter-Harris type V fracture • Type V fracture is when there is a crush injury to the physis
  27. 27. Treatment of Compound Fracture
  28. 28. Aim • To convert contaminated wound into clean wound • To convert the open # into a closed one. • To establish a union in a good position • To prevent pyogenic and clostridial infection. Order of Priority • Patient • Limb • Wound • Fracture
  29. 29. 4 Essentials of Treatment • Antibiotic Prophylaxis • Urgent Wound and Fracture Debridement • Stabilization of the Fracture • Early Debridement Wound Cover
  30. 30. Sterility and Antibiotic Cover • In most cases, Co-amoxiclav or Cefuroxime (or Clindamycin in case of penicillin allergy) is given ASAP • At time of debridement, Gentamycin is added to a second dose of the 1st antibiotic given • Wounds of Gustilo Grade 1 fractures can be closed at time of debridement; Antibiotic prophylaxis for up to 24hrs
  31. 31. • Grade 2 and 3A fractures, delayed closure after ‘second look’ is sometimes preferred • Grade 3B & C, delayed cover is usually practiced. • Total period of antibiotics is up to 72hrs.
  32. 32. Debridement • Thorough irrigation of wound with copious amounts of NS to remove all foreign material in wound, followed by excision of dead tissue • Tourniquet may be used to provide bloodless field, but it can cause ischemia and make it difficult to identify devitalized structures
  33. 33. • Principles observed during debridement: – Wound margin excision – Wound extension – Delivery of fracture – Removal of devitalized tissue – Wound cleansing • Uncontaminated wound in Grade 1 or 2 can be sutured
  34. 34. Fracture Stabilization • Important in reducing risk of infection and assisting recovery of soft tissues • Method of fixation depends on – Degree of contamination – Length of time from injury to operation – Extent of soft tissue damage • If there is no contamination and definitive wound cover can be achieved at time of debridement, all open #s can be treated as closed injury
  35. 35. • Internal or external fixation may be appropriate depending on individual characteristics of fracture and wound. • If wound cover is delayed, then external fixation is safer; however fixator pins should be inserted away from potential flaps • Internal fixation can be used at time of definitive wound cover as long as – delay to wound cover is < 7 days – No visible wound contamination – Internal fixation can control the # as well as external fixator
  36. 36. Stabilization of Open Fractures METHODS 1.PLASTER IMMOBILISATION 2.PINS & PLASTER 3.SKELETAL TRACTION 4.EXTERNAL FIXATION 5.INTERNAL FIXATION 6.HYBRID FIXATION
  37. 37. External Fixators Method of choice in most open fractures Advantages: • Easily applied • Good skeletal & soft tissue stability • Anatomical reduction. • No additional trauma • Risk of infection is comparatively less. • Allows wound inspection & wound dressing. • Assist in restoring the limb to length until definitive fixation • Allows transportation • Better nursing care
  38. 38. Amputation Indications: • Vascular injury – no repair possible • Functional outcome better with prosthesis • Life saving to arrest bleeding • Associated diseases (DM)
  39. 39. Thank You

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