GeneralG06FXclassificationJTGrev2310章节.ppt

Grouping-Type B Spiral wedge Bending wedge Fragmented wedge Grouping-Type C Spiral multifragmentary wedge Segmental Irregular Subgrouping Differs from bone to bone Depends on key features for any given bone and its classification The purpose is to increase the precision of the classification OTA Classification It is an evolving system Open for change when appropriate Allows consistency in research Builds a description of the fracture in an organized, easy to use manner Classification of Soft Tissue Injury Associated with Fractures Closed Fractures Fracture is not exposed to the environment All fractures have some degree of soft tissue injury Commonly classified according to the Tscherne classification Don’t underestimate the soft tissue injury as this affects treatment and outcome! Closed Fracture Considerations The energy of the injury Degree of contamination Patient factors Additional injuries Tscherne Classification Grade 0 Minimal soft tissue injury Indirect injury Grade 1 Injury from within Superficial contusions or abrasions Tscherne Classification Grade 2 Direct injury More extensive soft tissue injury with muscle contusion, skin abrasions More severe bone injury (usually) Tscherne Classification Grade 3 Severe injury to soft tisues -degloving with destruction of subcutaneous tissue and muscle Can include a compartment syndrome, vascular injury Closed tibia fracture Note periosteal stripping Compartment syndrome Literature Prospective study Tibial shaft fractures treated by intramedullary nail Open and closed 100 patients Gaston, JBJS-B, 1999 Literature What predicts outcome? Classifications used: AO Gustilo Tscherne Winquist-Hansen (comminution) All x-rays reviewed by single physician Evaluated outcomes Union Additional surgery Infection Tscherne classification more predictive of outcome than others Gaston, JBJS-B, 1999 Open Fractures A break in the skin and underlying soft tissue leading into or communicating with the fracture and its hematoma O