Rockwood, Green, and Wilkins' Fractures, 10e Package

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Classification of Fractures Shikha Sachdeva, Brandi Hartley, and Craig Roberts

recognized. Ideally, reliability is assessed, and categories or definitions are subsequently modified prior to adopting new classification schemes. The alpha numeric fracture code, orig inally developed by the Arbeitsgemeinschaft für Osteosynthe sefragen (AO) and expanded and refined by workgroups of the Orthopaedic Trauma Association (OTA) and AO, has made an international universal classification a near reality. Ultimately, the value of fracture classification lies in its application: imme diate application to clinical decision making (provided it can be applied efficiently and in real-time), and later application to outcomes research, artificial intelligence (AI), and predictive analytics. Previously a common topic of discussion both at scientific meetings and in orthopaedic journals, the analysis of fracture classification has decreased in popularity throughout the past several decades. In the 1990s, the journal Surgical Rounds for Orthopaedics had a regular column entitled “Fracture Eponym of the Month,” and full textbooks were dedicated to fracture eponyms, such as The Language of Fractures . 54 Conversely, now there are reference texts for orthopaedic traumatology that elect not to include a chapter specific to fracture classification. None theless, the 2018 OTA/AO Fracture Compendium 38 has resulted in a rekindling of interest and scientific publication on fracture classification. This chapter will describe how advanced imaging has changed and expanded fracture classification. It is also important to discuss the use of AI, which is likely to play an increasingly larger role in practice management and fracture classification as well. With advances in imaging and computer- based analysis, there will always be an important need to clas sify new knowledge through a well-defined scientifically valid process.

INTRODUCTION 113 BACKGROUND AND HISTORY 113 PURPOSE AND APPLICATION OF FRACTURE CLASSIFICATION 114 Common Language and Terminology 114 Treatment and Prognosis 115 Research 115 Education 115 LIMITATIONS AND CHALLENGES OF FRACTURE CLASSIFICATION SYSTEMS 116 Reliability 116 Validity 116 Measurement 116 Categorizing Continuous Variables 116 CURRENT STATE OF CLASSIFICATION OF FRACTURES 117 Fracture-Specific Classifications 117 OTA/AO 2018 Fracture Compendium Classification 120 Selected Recent Studies on the OTA/AO 2018 Fracture Compendium Classification 122 Soft Tissue Injuries Associated With Closed Fractures: Advent of MRI 124 OPEN FRACTURES 126 The Gustilo–Anderson Classification 126 Open Fractures and the OTA/AO Open Fracture Classification 126 ARTIFICIAL INTELLIGENCE AND MACHINE LEARNING 127 SUMMARY 128

INTRODUCTION

BACKGROUND AND HISTORY

Fracture classification serves many important purposes: com munication, research, education, and as a guide to treatment and prognosis. The scientific basis of modern classification has improved from the past, and most new classifications now result from a group consensus process directed by committees or task forces of major organizations. The need to optimize the reliability and validity of classification schemes is now well

Throughout much of the 19th and early 20th centuries, var ious fractures were named by the individuals who described them. For example, the term Colles’ fracture persists, describ ing dorsal displacement of the distal end of the radius with volar apex angulation in a “dinner fork” configuration. This

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