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“MUST KNOW” CLASSIFICATIONS

Gustillo

Salter-Harris

“MUST KNOW” CLASSIFICATIONS Gustillo Salter-Harris Salter-Harris fractures are epiphyseal plate fractures and are common and important

Salter-Harris fractures are epiphyseal plate fractures and are common and important as they can result in premature closure and therefore limb shortening and abnormal growth.

Conveniently the Salter-Harris types can be remembered by the mnemonic SALTR.

type I slipped

5-7%

fracture plane passes all the way through the growth plate, not involving bone cannot occur if the growth plate is fused reference required good prognosis

type II above ~ 75% (by far the most common) fracture passes across most of the growth plate and up through the metaphysis good prognosis

type III lower

7-10%

fracture plane passes some distance along the growth plate and down through the epiphysis poorer prognosis as the proliferative and reserve zones are interrupted

type IV through or transverse or together intra-articular

10%

fracture plane passes directly through the metaphysis, growth plate and down through the epiphysis poor prognosis as the proliferative and reserve zones are interrupted

type V ruined or rammed uncommon < 1% crushing type injury does not displace the growth plate but damages it by direct compression worst prognosis

Neer

type IV t hrough or t ransverse or t ogether intra-articular 10% fracture plane passes directly

This system of classification includes four segments. • The head of the humerus. • The greater tuberosity. • The lesser tuberosity. • The shaft of the humerus.

According to Neer, a fracture is displaced when there is more than 1 cm of displacement and 45° of angulation of any one fragment with respect to the others. Displacements occur because of the muscle pull.

  • a. The supraspinatus and the Infraspinatus pull the greater tuberosity superiorly.

  • b. The Subscapularis pulls the lesser tuberosity medially.

  • c. The Pectoralis Major adducts the shaft medially.

The ‘Two-part fractures’ involve any of the 4 parts and

include 1 fragment that is displaced. The ‘Three-part fractures’ include a displaced fracture of the surgical neck in addition to either a displaced greater tuberosity or lesser tuberosity fracture. The ‘Four-part fractures’ include displaced fracture of the surgical neck and both tuberosities.

Pipkin Classification of Femoral Head Fractures

Pipkin Classification of Femoral Head Fractures Garden’s classification : Fracture of Neck of Femur (Figs 3.53

Garden’s classification : Fracture of Neck of Femur (Figs 3.53 and 3.54A to D) Stage-I–Incomplete fracture (or valgus impaction). Stage-II–Complete fracture without displacement. Stage III–Complete fracture with minimal displacement. Stage IV–Complete fracture with marked displacement.

Pipkin Classification of Femoral Head Fractures Garden’s classification : Fracture of Neck of Femur (Figs 3.53

Based on Evans’ classification of intertrochanteric fracture (1949) classified as follows (Fig. 3.59)

Type I–Undisplaced 2-fragment fracture. Type II–Displaced 2-fragment fracture. Type III–3-fragment fracture without posterolateral support. Type IV–3-fragment fracture without medial support. Type V–4-fragment fracture without posterolateral and medial support.

Type VI—Reversed obliquity fracture.

Type VI—Reversed obliquity fracture. “GOOD TO KNOW” CLASSIFICATIONS Group A–Extra-articular fractures, i.e. Supracondylar fractures. Group B–Intra-articular

“GOOD TO KNOW” CLASSIFICATIONS

Type VI—Reversed obliquity fracture. “GOOD TO KNOW” CLASSIFICATIONS Group A–Extra-articular fractures, i.e. Supracondylar fractures. Group B–Intra-articular

Group A–Extra-articular fractures, i.e. Supracondylar fractures. Group B–Intra-articular fractures involving one condyle, either lateral (common) or medial. Group C–Bicondylar intra-articular fractures. These are basically intercondylar fractures with supracondylar extension. ‘T’and ‘Y’ fractures.