Fractures

Types of #

What is the Neer

classification?
What the two main components of
the classification?

What is the Neer

classification?
1. Number of fracture parts
2. Displacement

How does the neer classification

divide the humerus?

How does the neer classification

divide the humerus?
4 parts
1.
2.
3.
4.

humeral head
Greater tuberosity
lesser tuberosity
humeral shaft

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

What is a one-part fracture?

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

Two Part Fracture?

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
3. Surgical neck (MOST COMMON)
4. Greater tuberosity (anterior shoulder disclocation). NB for
GT # lower threshold for displacement (>5mm)
5. Anatomical neck
6. Lesser tuberosity uncommon
2 part fractures = 20% proximal humeral fractures

3 part #?

3 part fracture
1. Fracture lines: 3-4 parts
2. 2 parts displaced (>1cm OR >45 degrees)
Two 3-part # patterns exist
3. GT and shaft are displaced with respect to lesser
tuberosity and articular surface, which remain
together (MOST COMMON)
4. Lesser tuberosity and shaft are displaced with respect
to GT and articular surface, which remain together
5% proximal humeral #

4 part #

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!!!

Classification of clavicle
fractures?

Classification of clavicle
fractures?
What are the groups of clavicle
fractures?

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) (1015%)
3. Group 3 Medial third (5-8%)

How are group 1 #

subdivided?

How are group 1 #

subdivided?
Non-displaced less than 100%
displacement treated nonoperatively
Displaced >100% displacement
(nonunion rate 4.5%) treated
operatively

How are group 2 classified

(Neer)

Type 1
Type 2a
2b:
3
4
5

What is a Group 2 Type 1 fracture

and how is it managed?

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

What is a Group 2, Type 2a

#?
# = medial to INTACT conoid and
trapezoid ligaments
Medial clavicle UNSTABLE
56% = nonunion with nonoperative
mx
Treat operatively

What is G2, Type 2b

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

What is G2, Type 3

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

G2, Type 4?

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

G2, Type 5
Comminuted #
Conoid and trapezoid = attached to
comminuted fragment
Medial Clavicle UNSTABLE
OPERATIVE treatment

Group 3 # - Medial 1/3

How is this category subdivided?

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

Types of hip fracture?

Types of hip fracture?

Gardens classification of hip

fractures

Gardens 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

Evans Classification of
Intertrochanteric Fractures?

Evans Classification of
Intertrochanteric Fractures?

Eponymous distal radial

fracture?

Eponymous distal radial

fracture?

Bartons dorsal and volar

Colles
Chauffeurs
Intra-articular
Smiths

What is Bartons 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

What is Bartons 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 bartons

Bartons fractures

Colles
Low energy extra articular fracture
Typically DORSALLY displaced
Typically Angulated
MOI: forced dorsiflexion of
outstretched wrist
Associated Injuries: ulnar styloid
fracture

Smiths
Types?

Smiths
Types?
Type 1: Extra-articular
Type 2: crosses into the dorsal
articular surface
Enters radiocarpal joint
Volar bartons # = Smiths Type 3

Smiths
MOI: fall backwards onto palm of
outstretched hand
Tx:
ORIF for volar displaced #
K wire for smiths type 2

Chauffeurs
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
bartons

Ankle Fractures
Weber

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