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Classifications Flashcards

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1
Q

Wilson-Katz Classification

A

Stress fractures

  • Type 1
  • Type 2
  • Type 3
  • Type 4
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2
Q

WK type 1

A

Type I: Fracture line with no evidence of endosteal callus or periosteal reaction
o Looks like a radiolucent line following injury due to osteoclastic activity
o Example: Jones fracture or any acute fracture (this is the only thing you will see in an acute injury on x-ray)

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3
Q

WK type 2

A
  • Type II: Focal sclerosis and endosteal callus
    o Radiopaque due to sclerosis
    o Cancellous bones will show this more than any other type of bone
    o You will see this at the base or the heads of the metatarsals
    o Also in the tarsal bones, calcaneus, metaphysis of the tibia
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4
Q

WK type 3

A
  • Type III: Periosteal reaction and external callus
    o Shaft of metatarsal is common site of periosteal reaction due to movement in the shaft of the metatarsal (more so than the ends which are locked in a joint)
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5
Q

WK type 4

A
  • Type IV: Mixed combination of above
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6
Q

Notes on WK classification

A

o X-ray will show sclerosis (W-K II) if fracture in cancellous bone (ends of metatarsal bones, tarsal bones, proximal and distal tibia and fibula)
o Microfracture of trabeculae is first event to occur and incites osteoblastic activity

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7
Q

Stewart Classification

A

5th Metatarsal Fractures

  • Type 1
  • Type 2
  • Type 3
  • Type 4
  • Type 5
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8
Q

Stewart type 1

A

True Jones fracture at the metaphysis of the 5th met base

Due to rotation of the forefoot with the base of the 5th met remaining fixed - NOT seen with inversion ankle sprains

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9
Q

Stewart type 2

A

Intra-articular fracture of the base of the 5th met

Results from contraction of the peroneus brevis

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10
Q

Stewart type 3

A

Avulsion of the 5th met base

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11
Q

Stewart type 4

A

Comminuted intra-articular fracture of the base of the 5th met

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12
Q

Stewart type 5

A

Partial avulsion fracture of the epiphysis (located in a longitudinal direction)

There is risk of Iselin’s AVN with thtis type of fracture

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13
Q

Torg Classification

A

Jones fracture classification

  • Type 1
  • Type 2
  • Type 3
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14
Q

Torg type 1

A

Acute Jones fracture

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15
Q

Torg type 2

A

Delayed union of a Jones fracture or diaphyseal stress fracture

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16
Q

Torg type 3

A

Non-union of a Jones fracture or a diaphyseal stress fracture

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17
Q

Oloff and Jacobs classification

A

Hallux limitus

  • Grade 1
  • Grade 2
  • Grade 3
  • Grade 4
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18
Q

Oloff and Jacobs grade 1

A

Pre-hallux limitus

  • Metatarsus primus elevatus, plantar subluxation of the proximal phalanx on the 1st met head and a pronatory component of the rearfoot
  • Pain with end ROM
  • Deformity is functional in nature with minimal adaptive changes
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19
Q

Oloff and Jacobs grade 2

A
  • Some flattening of the met head with a possible osteochondral defect
  • Pain on end ROM and structural adaptation has occurred
  • Passive ROM is limited but is most pronounced with forefoot loading
  • Small dorsal exostosis common
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20
Q

Oloff and Jacobs grade 3

A
  • More severe flattening of the met head, osteophytic production and large dorsal exostosis on both proximal phalanx and met head
  • Non-uniform joint space narrowing, crepitus
  • Pain on full ROM
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21
Q

Oloff and Jacobs grade 4

A

Grade 4

  • More severe form of grade 3 with obliteration of the joint space, loose bodies present in the joint space or capsule
  • <10 degrees of total MTPJ motion
  • May have associated inflammatory arthritis
  • May be asymptomatic if ankylosis has occurred
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22
Q

Johnson and Strom

A

Posterior Tibial Tendon Dysfunction (PTTD)

  • Stage 1
  • Stage 2
  • Stage 3
  • Stage 4

Categorized based on:

  • Condition of PTT
  • Deformity
  • Pain
  • Ability to do single limb heel rise
  • Too many toes sign
  • Valgus/arthritis
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23
Q

Johnson and Strom stage 1

A
  • Tenosynovitis, but no degeneration of PTT
  • Medial pain
  • Mild weakness on heel rise
  • Hindfoot inverts on heel rise
  • Negative too many toes sign
  • No valgus or arthritis
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24
Q

Johnson and Strom stage 2

A
  • Elongation and degeneration of PTT
  • Flexible, reducible pes planus
  • Pain medial, lateral or both
  • Moderate weakness on heel rise
  • Absent or little inversion on heel rise
  • Positive too many toes sign
  • No valgus or arthritis
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25
Johnson and Strom stage 3
- Elongation and degeneration of PTT - Fixed, non-reducible pes planus - Pain medial, lateral or both - Unable to do heel rise or no inversion with heel rise - Positive too many toes sign - No valgus or arthritis
26
Johnson and Strom stage 4
- Elongation and degeneration of PTT - Fixed, non-reducible pes planus - Pain medial, lateral or both - Unable to do heel rise or no inversion with heel rise - Positive too many toes sign - YES - valgus or arthritis
27
Sedden classification
Nerve injuries - Neuropraxia - Axonotomesis - Neurotomesis
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Neuropraxia
Interruption of the nerve impulse due to external nerve pressure resulting in pinpoint segmental demyelination
29
Axonotomesis
Severance of individual nerve fibers resulting in partial or complete severance of the nerve
30
Neurotomesis
Complete severance of the nerve resulting in Wallerian degeneration NOTE: Wallerian degeneration is a process that results when a nerve fiber is cut or crushed and the part of the axon distal to the injury (i.e. farther from the neuron's cell body) degenerates
31
Sunderland Classification
Nerve injuries - 1st degree - 2nd degree - 3rd degree - 4th degree - 5th degree
32
Sunderland 1st degree
Disruption of neurological impulses without Wallerian degeneration
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Sunderland 2nd degree
Disruption of the axon with Wallerian degeneration distal to the point of trauma
34
Sunderland 3rd degree
Fibrous and obstruction of the nerve, regrowth with fusiform swelling
35
Sunderland 4th degree
Incomplete severance of the nerve
36
Sunderland 5th degree
Complete severance of the nerve
37
Hardcastle/Myerson Classification
Lisfranc fracture/dislocation - Type A (A1 and A2) - Type B (B1 and B2) - Type C (C1 and C2)
38
Hardcastle/Myerson type A (A1 and A2)
Total displacement - A1: lateral displacement - A2: dorsoplantar displacement
39
Hardcastle/Myerson type B (B1 and B2)
Partial displacement - B1: medial dislocation of 1st metatarsal - B2: lateral dislocation of lesser metatarsals
40
Hardcastle/Myerson type C (C1 and C2)
Divergent (1st met medial while lessers go lateral) - C1: 1st met displaces medially, some lesser mets laterally displace - C2: 1st met displaces medially, all lesser mets laterally displace
41
Quene and Kuss
Lisfranc fracture/dislocations - Homolateral - Isolateral - Divergent
42
Homolateral
All 5 mets are displaced in the transverse plane
43
Isolateral
1 or 2 mets are displaced in the transverse plane
44
Divergent
Displacement is in both the sagittal and transverse plane
45
Rowe Classification
Calcaneal fractures - Type I (A, B, C) - Type 2 (A, B) - Type 3 - Type 4 - Type 5
46
Rowe type 1A
Fracture of the tuberosity Due to inversion or eversion
47
Rowe type 1B
Fracture of the sustentaculum tali Due to twist on a supinated foot
48
Rowe type 1C
Fracture of the anterior tubercle Due to plantarflexion on a supinated foot MOST COMMON TYPE (also most common in FEMALES)
49
Rowe type 2A
Beak fracture without Achilles insertion involvement
50
Rowe type 2B
Avulsion of the Achilles tendon
51
Rowe type 3
Fracture of the body without STJ involvement MOST COMMON extra-articular calcaneal fracture
52
Rowe type 4
Fracture of the body with STJ involvement
53
Rowe type 5
Comminution of the body of the calcaneus
54
Essex Lopressti classification
Calcaneal fractures - Type 1 (tongue type) - Type 2 (joint depression type)
55
Essex Lopressti type 1
Tongue type - 1st fracture line running superior to inferior - 2nd fracture line exiting the posterior aspect of the calcaneus
56
Essex Lopressti type 2
Joint depression type - 1st fracture line running superior to inferior - 2nd fracture line surrounding the STJ
57
Sanders classification
Calcaneal fractures (MUST use CT) - Type 1 - Type 2 - Type 3 - Type 4 Modifiers are used which divide the posterior facet into 3 equal portions by lines A, B and C - A = lateral - B = middle - C = sustentaculum tali Remember SC... Sanders CT and Sustentaculum C
58
Sanders type 1
All non-displaced fractures no matter how many fragments
59
Sanders type 2
2 part fracture of the posterior facet - fracture line is either A, B or C
60
Sanders type 3
3 part fracture of the posterior facet - fracture line is combinations of AB, AC or BC
61
Sanders type 4
4 part fracture with high degree of comminution
62
Hanover classification
Calcaneal fractures - CT scan evaluation based on fracments involved and number of joint fractures 5 fragments - Sustentaculum tali - Tuberosity - STJ - Anterior process - Anterior STJ fragment Most common is the 5 fragment/2 joint surface
63
Danis-Weber
Ankle fractures - A = fibular fracture below ankle joint - B = fibular fracture at ankle joint - C = fibular fracture above joint
64
Lauge Hansen
Ankle fractures - Supination adduction (SAd) - Pronation abduction (PAb) - Supination external rotation (SER) - Pronation external rotation (PER)
65
Supination adduction (SAd)
DW A - starts LATERAL - 1: rupture lateral collaterals or TRANSVERSE fibular fracture below ankle joint - 2: VERTICAL fracture of medial malleolus
66
Pronation abduction (PAb)
DW B - starts MEDIAL - 1: rupture deltoid or TRANSVERSE medial malleolus fracture - 2: disruption of AITFL and PITFL, T-C fracture or Wagstaff fracture - 3: SHORT oblique/comminuted fracture of fibula at ankle joint
67
Supination external rotation (SER)
DW B - starts ANTERIOR - MOST COMMON - 1: disruption of AITFL, T-C fracture or Wagstaff fracture - 2: SPIRAL fracture of fibula at ankle joint (posterior spike) - 3: disruption of PIFTF - 4: rupture deltoid or transverse medial malleolus fracture
68
Pronation external rotation (PER)
DW C - starts MEDIAL - 1: rupture deltoid or TRANSVERSE medial malleolus fracture - 2: disruption of AITFL or rupture of interosseous membrane - 3: fibular fracture proximal to syndesmosis - 4: disruption of PITFL
69
Meuller Classification
``` Medial malleolar fractures o A = Avulsion o B = Transverse at level of mortise o C = Oblique o D = Near vertical ```
70
Ottawa ankle rules
Developed by ER physicians to reduce unnecessary radiographs, order only if: o Bony tenderness along distal 6 cm of tibia or fibula o Bony tenderness at distal tip of tibia or fibula o Bony tenderness at 5th metatarsal base o Bony tenderness at navicular o Inability to bear weight or walk 4 steps
71
Volkman fracture
o Volkmann fracture: avulsion of PITFL off tibia >> P tib
72
Tilleaux-Chaput fracture
Tilleaux-Chaput fracture: avulsion of AITFL off tibia >> A tib
73
Wagstaff fracture
Wagstaff fracture: avulsion of AITFL off fibula >> A fib
74
Bosworth fracture
Bosworth fracture: avulsion of PITFL >> P fib
75
Maisonneuve fracture
Weber C type proximal fibular fracture within 10 cm of fibular neck
76
Saltar Harris classification
Physeal plate trauma - Type 1 (S = slip) - Type 2 (A = above) - Type 3 (L = lower) AKA Tillaux fracture - Type 4 (T = through) - Type 5 (R = really bad, impaction resulting in comminution, halts growth)
77
Hawkins classification
Talar neck fractures - Type 1 - Type 2 - Type 3 - Type 4
78
Hawkins type 1
Vertical fracture of the talar neck without displacement, disruption of 1 blood vessel AVN risk 12%
79
Hawkins type 2
Vertical fracture of talar neck with dislocation of the talar body from the STJ, disruption of 2 blood vessels AVN risk 42%
80
Hawkins type 3
Vertical fracture of the neck of the talus, dislocation of the STJ and ankle, disruption of 2 blood vessels AVN risk 91%
81
Hawkins type 4
Type 3 with addition of displacement of the TN joint and disruption of 3 blood vessels AVN risk 95%
82
Talar dome mechanism of injury
DIAL A PIMP - DIAL: anterior lateral lesion from dorsiflexion and inversion - WAFER shaped fragment - PIMP: posterior medial lesion from plantarflexion and inversion/external rotation- CUP shaped fragment
83
Berndt Hardy
Talar dome fractures - Stage 1 - Stage 2 - Stage 3 - Stage 4
84
Berndt Hardy stage 1
Osteochondral compression of the talar dome
85
Berndt Hardy stage 2
Partially detached, non-displaced osteochondral fracture
86
Berndt Hardy stage 3
Completely detached, non-displaced osteochondral fracture
87
Berndt Hardy stage 4
Displaced osteochondral fracture
88
Gustillo and Anderson
Open fractures - Type 1 - Type 2 - Type 3 (A, B, C)
89
Gustillo and Anderson Type 1
Open fracture with a wound <1 cm and clean 0-2% risk of infection Antibiotics: - Cefazolin 2 g IV initially, Cefazolin 1 g IV q8 hrs for 48-72 hrs
90
Gustillo and Anderson Type 2
Open fracture with a laceration >1 cm without extensive soft tissue damage 2-7% risk of infection Antibiotics: - Cefazolin 2 g IV initially, Cefazolin 1 g IV q8 hrs for 48-72 hrs - Gentamicin 1.5 mg/kg IV initially, Gentamicin3.5-5 mg/kg/day divided for q8 hrs for 48-72 hrs
91
Gustillo and Anderson Type 3
Open fracture with extensive soft tissue damage (>5 cm wound) ``` A = adequate soft tissue coverage >> 7% risk of infection B = extensive soft tissue damage with periosteal stripping >> 50% risk of infection C = arterial injury requiring repair >> 25-50% risk of infection, 50% risk of amputation ``` Antibiotics: - Cefazolin 2 g IV initially, Cefazolin 1 g IV q8 hrs for 48-72 hrs - Gentamicin 1.5 mg/kg IV initially, Gentamicin3.5-5 mg/kg/day divided for q8 hrs for 48-72 hrs - SOIL CONTAMINATION/FARM INJURY: Add Penicillin for anaerobic coverage
92
Eckert and Davis
Peroneal subluxation - Grade I - Grade II - Grade III
93
Eckert and Davis grade 1
Retinaculum ruptures from the cartilaginous lip and lateral malleolus
94
Eckert and Davis grade 2
Distal edge of fibrous lip is elevated with the retinaculum
95
Eckert and Davis grade 3
Thin fragment of bone is avulsed from the deep surface of the Peroneal retinaculum and deep fascia
96
Kuwada classification
Achilles tendon rupture - Type 1 - Type 2 - Type 3 - Type 4
97
Kuwada type 1
Partial tear of <50%
98
Kuwada type 2
Complete tear with defect after debridement <3 cm
99
Kuwada type 3
Complete tear with defect after debridement 3-6 cm
100
Kuwada type 4
Complete tear with defect after debridement >6 cm
101
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