Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Fracture

  • Login to see the comments

Fracture

  1. 1. Fractures
  2. 2. Types of #
  3. 3. What is the Neer classification? • What the two main components of the classification?
  4. 4. What is the Neer classification? 1. Number of fracture parts 2. Displacement
  5. 5. How does the neer classification divide the humerus?
  6. 6. How does the neer classification divide the humerus? • 4 parts – 1. humeral head – 2. Greater tuberosity – 3. lesser tuberosity – 4. humeral shaft
  7. 7. How does the Neer classification displacement? • Displacement = per part basis • Fracture part = displaced if angulation >45 degrees OR if the fracture is displaced by >1cm • Simplest displaced fracture = 2 part fracture, HOWEVER a minimally displaced fracture even with multiple fracture lines = type 1, one part fracture
  8. 8. What is a one-part fracture?
  9. 9. What is a one-part fracture? 1. Fracture line = 1-4 parts 2. None of the parts are displaced NB. Type 1 = 70-80% of all proximal humeral fracture – conservative treatment
  10. 10. Two Part Fracture?
  11. 11. Two Part Fracture? 1. Fracture lines = 2-4 parts 2. One part is displaced either angulation >45degrees or displaced >1cm Four possible type of 2part fractures exist for each division of the humerus 1. Surgical neck (MOST COMMON) 2. Greater tuberosity (anterior shoulder disclocation). NB for GT #– lower threshold for displacement (>5mm) 3. Anatomical neck 4. Lesser tuberosity – uncommon 2 part fractures = 20% proximal humeral fractures
  12. 12. 3 part #?
  13. 13. 3 part fracture 1. Fracture lines: 3-4 parts 2. 2 parts displaced (>1cm OR >45 degrees) Two 3-part # patterns exist 1. GT and shaft are displaced with respect to lesser tuberosity and articular surface, which remain together (MOST COMMON) 2. Lesser tuberosity and shaft are displaced with respect to GT and articular surface, which remain together 5% proximal humeral #
  14. 14. 4 part #
  15. 15. 4 part # • Fracture lines involve parts • 3 parts = displaced >1cm or >45 degrees)with respect to the 4th part • Uncommon <1% of proximal humeral fractures • Poor non-operative results, articular surface no longer attached to any part of the humerus • High incidence of AVN Operative management required!!!
  16. 16. Classification of clavicle fractures?
  17. 17. Classification of clavicle fractures? What are the groups of clavicle fractures?
  18. 18. Classification of clavicle fractures? What are the groups of clavicle fractures? 1. Group 1 – Middle third (80-85%) 2. Group 2 – Lateral Third (Neer classification of the clavicle) (10-15%) 3. Group 3 – Medial third (5-8%)
  19. 19. How are group 1 # subdivided?
  20. 20. How are group 1 # subdivided? • Non-displaced – less than 100% displacement – treated non-operatively • Displaced >100% displacement (nonunion rate 4.5%) – treated operatively
  21. 21. How are group 2 classified (Neer) • Type 1 • Type 2a • 2b: • 3 • 4 • 5
  22. 22. What is a Group 2 Type 1 fracture and how is it managed?
  23. 23. What is a Group 2 Type 1 fracture and how is it managed? • Lateral to coracoclavicular (trapezoid and conoid) ligaments OR is interligamentous • USUALLY minimally displaced • STABLE because conoid and trapezoid are intact • Non operative treatment
  24. 24. What is a Group 2, Type 2a #? • # = medial to INTACT conoid and trapezoid ligaments • Medial clavicle UNSTABLE • 56% = nonunion with nonoperative mx • Treat operatively
  25. 25. What is G2, Type 2b
  26. 26. What is G2, Type 2b • Fracture = between ruptured conoid and intact trapezoid OR lateral to both ligaments TORN • Medial clavicle UNSTABLE 30-45% nonunion with nociceptive management Operative treatment
  27. 27. What is G2, Type 3
  28. 28. What is G2, Type 3 • Intrarticular – extends into AC joint • Conoid and trapezoid = INTACT = STABLE • Patients may develop post-traumatic AC arthritis • Test AC arthritis with scarf test • Non-operative
  29. 29. G2, Type 4?
  30. 30. G2, Type 4? • Physeal fracture – skeletally immature • Displacement of lateral clavicle occurs superiorly – tear in periosteum • Conoid and trapezoid overall remain attached to periosteal sleeve and fracture is STABLE! • Treatment therefore =NONOPERATIVE
  31. 31. G2, Type 5 • Comminuted # • Conoid and trapezoid = attached to comminuted fragment • Medial Clavicle UNSTABLE • OPERATIVE treatment
  32. 32. Group 3 # - Medial 1/3 How is this category subdivided?
  33. 33. Group 3 # - Medial 1/3 How is this category subdivided? • Anterior Displacement: – Most often non-operative – Rarely symptomatic • Posterior Displacement: – RARE – Physeal fracture dislocation (<25yo) – Stability depends on costoclavicular ligaments – Potential for airway and great vessel compromise – Surgical management with thoracic surgeon
  34. 34. Types of hip fracture?
  35. 35. Types of hip fracture?
  36. 36. Garden’s classification of hip fractures
  37. 37. Garden’s classification of hip fractures • FEMORAL NECK FRACTURES • Stage 1: undisplaced incomplete, includes valgus impacted # • Stage 2: undisplaced complete • Stage 3: complete #, incompetely displaced • Stage 4: complete #, completely displaced
  38. 38. Evan’s Classification of Intertrochanteric Fractures?
  39. 39. Evan’s Classification of Intertrochanteric Fractures?
  40. 40. Eponymous distal radial fracture?
  41. 41. Eponymous distal radial fracture? • Barton’s – dorsal and volar • Colle’s • Chauffeur’s • Intra-articular • Smith’s
  42. 42. What is Barton’s fracture (dorsal)? • Distal radial fracture WITH dislocation of the radiocarpal joint • MOST COMMON # dislocation of the wrist • Often occurs alongside a radial styloid fracture • Operative treatment recommended – closed reduction, application of external fixation plus percutaneous pin insertion • Or ORIF through dorsal approach
  43. 43. What is Barton’s fracture (volar) • # volar margin of carpal surface of the radius • Associated with SUBLUXATION of the radiocarpal joint • Comminuted # distal radius may involve ant/post cortex • More common than dorsal barton’s
  44. 44. Barton’s fractures
  45. 45. Colle’s • Low energy extra articular fracture • Typically DORSALLY displaced • Typically Angulated • MOI: forced dorsiflexion of outstretched wrist • Associated Injuries: ulnar styloid fracture
  46. 46. Smith’s • Types?
  47. 47. Smith’s • Types? • Type 1: Extra-articular • Type 2: crosses into the dorsal articular surface • Enters radiocarpal joint • Volar barton’s # = Smith’s Type 3
  48. 48. Smith’s • MOI: fall backwards onto palm of outstretched hand • Tx: • ORIF for volar displaced # • K wire for smith’s type 2
  49. 49. Chauffeur’s • Radial styloid # • MOI: Tension forces sustained through ulnar deviation and supination of the wrist • Strong radiocarpal ligament, avulses the radial styloid from the metaphysis of the radius • Associated Injuries: Scapholunate dissocation, transstyloid perilunar dissociation, dorsal barton’s
  50. 50. Ankle Fractures • Weber
  51. 51. Ankle Fractures • Weber • A – BELOW level of ankle – Tibiofibular syndesmosis intact – Deltoid intact – Medial malleolus OFTEN FRACTURED – Usually stable • B – AT the level of the ankle joint, extending superiorly and laterally up the fibula – Tibiofibular syndesmosis intact OR partially torn, WITHOUT widening of the distal tibiofibular articulation – Medial malleolus may be fractured or deltoid ligament may be torn – Variable stability • C – ABOVE the level of ankle joint – Tibofibular syndesmosis disrupted with WIDENING of distal tibiofibular articulation – Medial malleolus fracture or deltoid ligament injury present – Unstable: ORIF

×