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

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CHAPTER 5 • Classification of Fracture

Figure 5-7. AP ( A ) and lateral ( B ) radio graphs of the distal tibia. Note when using the rule of squares ( yellow square ) whose sides are the same length as the widest portion of the epiphysis/metaphysis, this tibia fracture should be classified as an end- segment injury. (Reprinted with permission from Neer CS. Displaced proximal humeral fractures. II. Treatment of three-part and four-part displacement. J Bone Joint Surg Am. 1970;52(6):1090–1103.)

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Knutson et al. reported on 118 femur fractures randomly selected from the Swedish Fracture Register and noted kappa values for interobserver agreement of 0.79 to 0.81 for the OTA/ AO group and 0.91 to 0.93 for the OTA/AO type. 29 Interestingly, these investigators noted that despite the fact that the classifica tions in the registry were made by “mostly inexperienced classi fiers,” the fracture classification in this national quality registry

was “accurate enough to permit the evaluation of fracture treat ment in specific groups of fractures.” 29 Pfluger et al. reported on the classification of 193 trimalleo lar ankle fracture. 47 These authors noted that the OTA/AO clas sification was a reliable system for characterizing trimalleolar fractures with the caveat that “it fails to provide solid informa tion about the posterior malleolus.” 47

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Figure 5-8. Fractures of the diaphyseal segment. A: Type A: Simple fractures have a single circumferential disruption of the diaphysis. B: Type B: Wedge fractures are characterized by contact between the main fragments after reduction usually restoring the normal length of the bone. The wedge fragment may be intact, or in multiple fragments (i.e., fragmentary wedge). C: Type C: Multifragmentary fractures consist of many fractures lines and fracture fragments. (Reprinted with permission from Meinberg E, et al. Fracture and dislocation classification compendium—2018 International Comprehensive Classification of Fractures and Dis locations Committee. J Orthop Trauma . 2018;32(1 Suppl):S1–S10. Copyright © 2018 by AO Foundation, Davos, Switzerland; Orthopaedic Trauma Association, IL, US.)

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