5. KRUGER’S GENERAL CLASSIFICATION
SIMPLE- no communication with exterior or interior
COMPOUND- communication through skin externally
through mucosa or PDL
6. KRUGER’S GENERAL CLASSIFICATION
COMMUNITED - splintering
crushed multiple pieces
violent forces / high velocity - fire arm / missiles
COMPLICATED / COMPLEX- damage to vital structures
complicates treatment
7. KRUGER’S GENERAL CLASSIFICATION
• IMPACTED – rare
one fragment driven firmly into the other
clinical movement not appreciable
• GREENSTICK -
one cortex broken and other bent
incomplete fracture- common children- resilience
9. ANATOMICAL CLASSIFICATION
• Rowe & Killey Classification
• A Fractures not involving basal bone
• Eg- dentoalveolar
• Fractures involving the basal bone
i. Single unilateral
ii. Double unilateral
iii. Bilateral
iv. multiple
10. DINGMAN & NATWIG CLASSIFICATION
A. SYMPHYSIS #
B. CANINE REGION #
C. BODY OF MANDIBLE #
D. ANGLE REGION #
E. RAMUS REGION #
F. CORONOID REGION #
G. CONDYLAR #
H. DENTOALVEOLAR #
11. RELATION OF FRACTURE TO THE SITE OF INJURY
DIRECT FRACTURES INDIRECT FRACTURES
(COUNTERCOUP)
12. COMPLETENESS
• Complete versus incomplete
1. Complete fractures
Adults - usually complete - interrupt entirely the continuity of the arch.
Usually mobile and have various degree of displacement.
13. COMPLETENESS
• INCOMPLETE FRACTURES
• Do not extend through both the buccal and the lingual cortices as well
as the alveolar and basal borders.
• Occasionally in adults , more often in children.
• nondisplaced and nonmobile.
• Might not require surgical treatment
14. Direction & favorability of treatment
Horizontally Favourable
Fracture line runs
downward & forward so
upward displacement
avoided
Horizontally
Unfavourable
Fracture line runs Down
Wards and Back Wards
so
upward Displacement
Unrestricted
15. VERTICALLY FAVORABLE VERTICALLY UNFAVORABLE
FRACTURE LINE RUNS FROM THE
OUTER BUCCAL PLATE OBLIQUELY
BACKWARDS AND LINGUALLY , MEDIAL
MOVEMENT RESTRICTED
FRACTURE LINE RUNS FROM THE
INNER LINGUAL PLATE OBLIQUELY
BACKWARDS AND BUCCALLY , MEDIAL
MOVEMENT UNRESTRICTED
16. DEPENDING UPON THE MECHANISM
I. AVULSION FRACTURE
II. BENDING FRACTURE
III. BURST FRACTURE
IV. COUNTERCOUP FRACTURE
V. TORSIONAL FRACTURE
18. ACCORDING TO SHAPE OF FRACTURE
TRANSVERSE
OBLIQUE
BUTTERFLY
OBLIQUE SURFACED
19. Presence or absence of teeth
Kazanjian V.H. & Converse J.M.
CLASS 1 TEETH ON BOTH
SIDES OF FRACTURE LINE
MONOMAXILLARY
CLASS II TEETH ONLY ON ONE SIDE
OF THE FRACTURE LINE
INTERMAXILLARY
FIXATION
CLASS III EDENTULOUS PATIENT OPEN REDUCTION
/ PROSTHESIS
20. AO Classification
F NO. OF FRACTURE OR FRAGMENTS
L LOCATION OF THE FRACTURE
O STATUS OF OCCLUSION
S SOFT TISSUE INVOLVEMENT
A ASSOCIATED FRACTURES
21. F: NO. OF FRACTURES
F0 Incomplete fractures
F1 Single fractures
F2 Multiple fractures
F3 Comminuted fractures
F4 Fracture with bone defect
27. GIVEN BY THE FRENCH SURGEON RENE LE-FORT IN 1901
AS
LEFORT I , II & III FRACTURES
28. Provides uniform method to describe the
level of major fracture lines .
Allows references regarding the probable
points of stability for surgical treatment .
Does not incorporate vertical or
segmental fractures, comminution or
bone loss .
29. ALSO CALLED :
• GUERINS FRACTURE
• FLOATING FRACTURE
• PTERYGOMAXILLARY
DYSJUNCTION
• HORIZONTAL FRACTURE
THERE IS COMPLETE SEPERATION
OF THE DENTOALVEOLAR PART OF
MAXILLA
AND THE FRAGMENT IS HELD ONLY
BY SOFT TISSUES.
LEFORT I FRACTURES
31. ALSO CALLED:
• PYRAMIDAL #
•SUBZYGOMATIC #
LEFORT II FRACTURE HAS A PYRAMIDAL
APPEARANCE ON THE PA SKULL .
MAXILLA IS SEPERATED FROM THE
SKULL BASE .
LEFORT II FRACTURES
36. ROWE AND WILLIAMS CLASSIFICATION -1985
A. FRACTURES NOT INVOLVING OCCLUSION :
I. Central Region :
a.Fractures of the nasal bones/nasal septum.
- Lateral nasal injuries
- Anterior nasal injuries
b. Fractures of frontal process of maxilla
c. Nasoethmoidal fractures
d. Fractures of type (a), (b) and (c) extending into the
frontal
bone (frontoorbitonasal dislocation).
II. Lateral region:
Fractures involving the zygomatic bone, arch and maxilla
excluding dentoalveolar component.
37. ROWE AND WILLIAMS CLASSIFICATION -1985
B. FRACTURES INVOLVING OCCLUSION :
Dentoalveolar
Subzygomatic
- Lefort I (low level or Guerin)
- Lefort II (Pyramidal Fracture)
Suprazygomatic
- Lefort III (High level)
38. RELATIONSHIP OF # LINE TO ZYGOMATIC BONE
1. BELOW ZYGOMATIC
subzygomatic fracture
1. ABOVE ZYGOMATIC
2. Suprazygomatic fracture
40. Modified LeFort Fracture
Classification - 1993
Le-Fort Level Description
I Low maxillary fracture
la Low maxillary fracture with multiple segments
II Pyramidal fracture
IIa Pyramidal fracture and nasal fracture
IIb Pyramidal and NOE fracture
III Craniofacial dysjunction
IIIa Craniofacial dysjunction and nasal fracture
IIIb Craniofacial dysjunction and NOE
IV II or III fracture and cranial base #
IVa + Supraorbital rim fracture
IVb + Anterior cranial fossa and supraorbial rim #
IVc + Anterior cranial fossa and orbital wall #
43. SCHIELDERUP (1950) :
TYPE 1 : Fractured zygoma hinged on maxillary & frontal
attachment.
TYPE 2 : Fractured and hinged on maxillary attachment
TYPE 3 : Fractured and hinged on frontal attachment
TYPE 4 : Fractured and detached enbloc.
TYPE 5 : Comminuted fracture.
44. KNIGHT AND NORTH’S CLASSIFICATION : 1961
Group I : Undisplaced fractures.
Group II : Arch fractures.
Group III : Unrotated body fractures.
Group IV : Medially rotated body fractures.
Group V : Laterally rotated body fractures.
Group VI : Complex fractures.
45. Rowe & Killey (1968)
Type I : No significant displacement
Type II : Fracture of the zygomatic arch
Type III : Rotation around vertical axis
- Inward displacement of orbital rim
- Outward displacement of orbital rim
Type IV : Rotation around longitudinal axis
- Medial displacement of frontal process
- Lateral displacement of frontal process
Type V : Displacement of the complex en bloc
- Medial
- Inferior
- lateral (Rare)
46. Rowe & Killey (1968)
Type VI : Displacement of orbitoantral partition
- Inferiorly
- Superiorly
Type VII : Displacement of orbital rim segments
Type VIII : Complex comminuted fractures.
55. MANSON AND COLLEAGUES (1990) :
Based on amount of energy dissipated & findings in
C.T. Scan-
a. High energy fractures.
b. Moderate energy fractures.
c. Low energy fractures.
56. MARKUS ZING (1992)
Type A : Incomplete zygomatic fracture.
Type B : Complete monofragment zygomatic fracture
(tetradpod fracture).
Type C : Multifragment zygomatic fracture.
57. ROWE’S & WILLIAM’S CLASSIFICATION :
1) Fractures stable after elevation
a. Arch only (medially displaced)
b. Rotation around the vertical axis.
Medially
Laterally
2) Fracture unstable after elevation.
a. Arch only (inferiorly displaced).
b. Rotation around the horizontal axis.
Medially
Laterally
.
58. ROWE’S & WILLIAM’S CLASSIFICATION :
c. Dislocations enblock
Inferior
Medially
Posterio-laterally.
d. Comminuted fracture
59. 1. Group A : Stable fracture – Showing minimal or no displacement and
requires no intervention.
2. Group B : Unstable fracture – With great displacement and distruption at
the frontozygomatic suture and comminuted fracture. Requires reduction
as well as fixation.
3. Group C : Stable fracture – Other types of zygomatic fractures, which
requires reduction, but no fixation.
4. Fractures of the zygomatic arch alone
• Minimum or no displacement.
• V type in fracture.
• Comminuted fracture.
LARSEN &THOMSEN CLASSIFICATION
60. MALAR CLASSIFICATION
TYPE 1 : Undisplaced fracture.
TYPE 2 : Arch fracture only.
TYPE 3 : Tripod malar fracture ( FZ intact ).
TYPE 4 : Tripod malar fracture (FZ distracted ).
TYPE 5 : Pure blow-out fracture..
TYPE 6 : Orbital rim fracture.
TYPE 7 : Comminuted and other fractures
61. SPIESSEL AND SCHROLL’S
CLASSIFICATION :
TYPE 1 : Isolated zygomatic arch fracture
TYPE 2 : Fracture with no significant
displacement
TYPE 3 : Partially displaced medially
TYPE 4 : Totally displaced medially
TYPE 5 : Those with dorsal displacement
TYPE 6 : Those with inferior displacement
TYPE 7 : Comminuted and other fractures
63. • NOE fractures are most commonly classified according to Markowitz
BL, Manson PN, Sargent L, et al (1991)
• Type I
• Type II
• Type III
• These can be unilateral or bilateral injuries.
• Plast Reconstr Surg. 87(5):843-53:
64. Type I
• In unilateral Markowitz type I fractures, there is a single large NOE
fragment bearing the medial canthal tendon.
• The nasal bone may also be involved and, in cases of comminution,
may not provide adequate dorsal support to the nasal bridge.
65. Unilateral Type II
• In unilateral type II fractures, there is often comminution of the
NOE area, but the canthal tendon remains attached to a fragment of
bone, allowing the canthus to be stabilized with wires or a small
plate on the fractured segment
66. Unilateral Type II + Involvement of the nasal bone
• The nasal bone may also be involved and, in cases of comminution,
may not provide adequate dorsal support to the nasal bridge.
67. Bilateral type II fracture with nasal bone
involvement
• bone grafting of the nasal dorsum may be necessary
68. Type III
• In type III fractures, there is often comminution of the NOE area (as
in type II fractures) and a detachment of the medial canthal tendon
from the bone.