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"Must Know" Classifications: Gustillo Salter-Harris

This document provides summaries of several orthopedic fracture classification systems: - Salter-Harris fractures of the epiphyseal plate are classified into 5 types based on the fracture plane's relationship to the growth plate. Types III, IV and V carry a poorer prognosis. - Neer classifications divide proximal humerus fractures into 2, 3, or 4-part fractures based on involvement of the surgical neck and greater and lesser tuberosities. - Garden's classification categorizes femoral neck fractures into 4 stages based on completeness and displacement of the fracture. - Evans classification divides intertrochanteric femur fractures into 6 types based on fragmentation and support. - Muller's

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Ho Yong Wai
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156 views

"Must Know" Classifications: Gustillo Salter-Harris

This document provides summaries of several orthopedic fracture classification systems: - Salter-Harris fractures of the epiphyseal plate are classified into 5 types based on the fracture plane's relationship to the growth plate. Types III, IV and V carry a poorer prognosis. - Neer classifications divide proximal humerus fractures into 2, 3, or 4-part fractures based on involvement of the surgical neck and greater and lesser tuberosities. - Garden's classification categorizes femoral neck fractures into 4 stages based on completeness and displacement of the fracture. - Evans classification divides intertrochanteric femur fractures into 6 types based on fragmentation and support. - Muller's

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Ho Yong Wai
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© © All Rights Reserved
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MUST KNOW CLASSIFICATIONS

Gustillo
Salter-Harris

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

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

Gardens classification : Fracture of Neck of Femur (Figs 3.53 and 3.54A to D)


Stage-IIncomplete fracture (or valgus impaction).
Stage-IIComplete fracture without displacement.
Stage IIIComplete fracture with minimal displacement.
Stage IVComplete fracture with marked displacement.

Based on Evans classification of intertrochanteric fracture (1949) classified as follows


(Fig. 3.59)
Type IUndisplaced 2-fragment fracture.
Type IIDisplaced 2-fragment fracture.
Type III3-fragment fracture without posterolateral support.
Type IV3-fragment fracture without medial support.
Type V4-fragment fracture without posterolateral and medial
support.

Type VIReversed obliquity fracture.

GOOD TO KNOW
CLASSIFICATIONS

Group AExtra-articular fractures, i.e. Supracondylar


fractures.
Group BIntra-articular fractures involving one condyle,
either lateral (common) or medial.
Group CBicondylar intra-articular fractures. These are
basically intercondylar fractures with supracondylar extension.
Tand Y fractures.

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