Distal radius fracture classification: Difference between revisions

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{{Distal radius fracture}}
{{Distal radius fracture}}
{{CMG}} {{AE}} {{VVS}}
 
{{CMG}}; {{AE}} {{Rohan}}
 
==Overview==
There are multiple classifications available for [[Distal radius fracture|distal radius fractures]]. The most common classification systems for [[Distal radius fracture|distal radius fractures]] include Frykman, Melone, Fernández, Universal, and AO classification.


==Classification==
==Classification==
In medicine, classifications systems are devised to describe patterns of injury which will behave in predictable ways, to distinguish between conditions which have different outcomes or which need different treatments. Most wrist fracture systems have failed to accomplish any of these goals and there is no consensus about the most useful one.  
 
There are multiple classifications available for [[Distal radius fracture|distal radius fractures]]. The most common classification systems for [[Distal radius fracture MRI|distal radius fractures]] include Frykman (1967), Melone (1984), Fernández (2001), Universal (Cooney 1993), and AO classification (Marsh et al. 2007).
 
===Frykman Classification===
* Frykman classified  [[distal radius fracture]] based on location.<ref name="pmid4175195">{{cite journal| author=Frykman G| title=Fracture of the distal radius including sequelae--shoulder-hand-finger syndrome, disturbance in the distal radio-ulnar joint and impairment of nerve function. A clinical and experimental study. | journal=Acta Orthop Scand | year= 1967 | volume=  | issue=  | pages= Suppl 108:3+ | pmid=4175195 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4175195  }} </ref>
{| class="wikitable"
! colspan="2" |Frykman Classification
|-
|I
|Extra-articular
|-
|II
|Extra-articular with [[ulnar fracture]]
|-
|III
|Intra-articular into [[radiocarpal joint]]
|-
|IV
|Intra-articular into [[radiocarpal joint]] with [[ulnar fracture]]
|-
|V
|Intra-articular into [[radioulnar joint]]
|-
|VI
|Intra-articular into [[radioulnar joint]] with [[ulnar fracture]]
|-
|VII
|Intra-articular into [[radiocarpal]] + radioulnar joints
|-
|VIII
|Intra-articular into [[radiocarpal]] + radioulnar joints with [[ulnar fracture]]
|}
 
===Melone Classification===
* Melone classified [[distal radius fracture]] based on location.<ref name="pmid8479722">{{cite journal| author=Melone CP| title=Distal radius fractures: patterns of articular fragmentation. | journal=Orthop Clin North Am | year= 1993 | volume= 24 | issue= 2 | pages= 239-53 | pmid=8479722 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8479722  }} </ref><ref name="pmid6728444">{{cite journal| author=Melone CP| title=Articular fractures of the distal radius. | journal=Orthop Clin North Am | year= 1984 | volume= 15 | issue= 2 | pages= 217-36 | pmid=6728444 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6728444  }} </ref>
{| class="wikitable"
! colspan="3" |Melone Classification
|-
|I
| colspan="2" |Undisplaced, no or minimal [[comminution]]
|-
| rowspan="3" |II
| colspan="2" |[[Die punch fracture]] with moderate to severe [[displacement]]
|-
|A
|Reducible
|-
|B
|Irreducible
|-
|III
| colspan="2" |Spike fragment present
|-
|IV
| colspan="2" |Wide separation of intra-articular fragments
|-
|V
| colspan="2" |Explosion fracture with severe [[comminution]], transverse split and rotational [[displacement]]
|}
 
===Fernández Classification===
* Fernández classified [[distal radius fracture]] based on [[trauma]] mechanism.<ref name="pmid11778328">{{cite journal| author=Fernandez DL| title=Distal radius fracture: the rationale of a classification. | journal=Chir Main | year= 2001 | volume= 20 | issue= 6 | pages= 411-25 | pmid=11778328 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11778328  }} </ref>
{| class="wikitable"
! colspan="2" |Fernández Classification
|-
|Type 1
|Bending [[Bone fracture|fracture]] of [[metaphysis]]
|-
|Type 2
|Shearing [[Bone fracture|fracture]] of joint surface
|-
|Type 3
|Compression [[Bone fracture|fracture]] of joint surface
|-
|Type 4
|Avulsion [[Bone fracture|fractures]] or [[radiocarpal]] [[fracture-dislocation]]
|-
|Type 5
|Combined [[Bone fracture|fractures]] associated with high high-velocity injuries
|}
 
===Universal Classification===
* Cooney classified [[distal radius fracture]] based on location and [[stability]].<ref name="pmid8479719">{{cite journal| author=Cooney WP| title=Fractures of the distal radius. A modern treatment-based classification. | journal=Orthop Clin North Am | year= 1993 | volume= 24 | issue= 2 | pages= 211-6 | pmid=8479719 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8479719  }} </ref>
{| class="wikitable"
! colspan="3" |Universal Classification
|-
|Type 1
| colspan="2" |Extra-articular [[Bone fracture|fracture]], without deviation
|-
| rowspan="4" |Type 2
| colspan="2" |Extra-articular [[Bone fracture|fracture]], with deviation
|-
|2A
|Reducible and stable
|-
|2B
|Reducible and unstable
|-
|2C
|Irreducible
|-
|Type 3
| colspan="2" |Intra-articular [[Bone fracture|fracture]], without deviation
|-
| rowspan="4" |Type 4
| colspan="2" |Intra-articular [[Bone fracture|fracture]], with deviation
|-
|4A
|Reducible and stable
|-
|4B
|Reducible and unstable
|-
|4C
|Irreducible
|}


===OTA System===
===OTA System===
The [http://www.ota.org/compendium/radius.pdf|Orthopaedic Trauma Association classification] is widely accepted and under constant review.  (More details available [[Bone fracture#OTA classification (Orthopaedic Trauma Association)|here]].)
*AO/ASIF  classification is the widely accepted classification.
*[[Radius (bone)|Radius]] is given the number 21 based on the classification.<ref name="pmid25042062">{{cite journal| author=Arealis G, Galanopoulos I, Nikolaou VS, Lacon A, Ashwood N, Kitsis C| title=Does the CT improve inter- and intra-observer agreement for the AO, Fernandez and Universal classification systems for distal radius fractures? | journal=Injury | year= 2014 | volume= 45 | issue= 10 | pages= 1579-84 | pmid=25042062 | doi=10.1016/j.injury.2014.06.017 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25042062  }} </ref>
*It is further subdivided as:
{| class="wikitable"
! colspan="3" |OTA System
|-
| rowspan="4" |A
| colspan="2" |Extra-articular fractures
|-
|A1
|[[Ulnar fracture]], [[Radius (bone)|radius]] intact
|-
|A2
|[[Radius fracture]], simple and impacted
|-
|A3
|[[Radius fracture]], multifragmentary
|-
| rowspan="4" |B
| colspan="2" |Partial articular fractures
|-
|B1
|[[Radius fracture]], sagittal
|-
|B2
|[[Radius fracture]], frontal, dorsal rim
|-
|B3
|[[Radius fracture]], frontal, volar rim
|-
| rowspan="4" |C
| colspan="2" |Complete articular fractures
|-
|C1
|Articular simple + [[metaphyseal]] simple
|-
|C2
|Articular simple, [[metaphyseal]] multifragmentary
|-
|C3
|Articular multifragmentary
|}


* (21-A) Extra-articular
===Types of Fractures based on Eponyms===
** (21-A2) Radius only
** (21-A3) Radius and ulna
* (21-B) Articular fracture involving articular surface of only one of the two bones
** (21-B2) Radius fractured, ulna intact
** (21-B3) Articular of one bone, extra-articular of other
* ((21-C) Articular fracture involving articular surface of two bones
** (21-C2) Simple of one, multifragmentary of other
** (21-C3) Multifragmentary of both


Details on further levels of subcoding are available [http://www.ota.org/compendium/radius.pdf here] (warning: PDF).
===[[Barton's Fracture]]===
*Fracture-dislocation of [[radiocarpal joint]] (with intra-articular fracture involving the volar or dorsal lip)


===Other Systems===
===[[Chauffer's Fracture]]===
The images from this system illustrate how varied the injury can be. [http://www.wheelessonline.com/ortho/fractures_of_the_radius Wheeless] details several classification systems, but comments "the classification does not include extent or direction of initial displacement, dorsal comminution, or shortening of the distal fragment; - hence, it is less useful in evaluating the outcome of treatment". These systems include:
*[[Bone fracture|Fracture]] of [[Radial styloid process|radial styloid]]


* [http://www.wheelessonline.com/ortho/frykman_classification_of_distal_radius_frx Frykman]
===[[Colles'Fracture]]===
* [http://www.wheelessonline.com/ortho/melone_classification_for_distal_radius_fractures Melone]  
*Dorsally displaced, extra-articular [[Bone fracture|fracture]]
* [http://www.wheelessonline.com/ortho/universal_classification_of_dorsal_displaced_radius_fractures Universal]. Universal codes include:
** Type I:  extra articular, undisplaced;
** Type II:  extra articular, displaced;
** Type III  intra articular, undisplaced;
** Type IV:  intra articular, displaced;


===General Features===
===[[Die-punch Fracture]]===
Although there is no formal scientific classification based on them, there are three features of the fracture that relate to outcome and to each other:
* Depressed [[Bone fracture|fracture]] of the [[lunate]] fossa (articular surface)
* stability of the fracture
* displacement (especially of the joint surface)  
* how severe the injury to the joint is


At one extreme a stable, undisplaced extra-articular fracture has an excellent prognosis. On the other an unstable, displaced intra-articular fracture is difficult to treat and has a poor prognosis.
===[[Smith's Fracture]]===
*Volar displaced, extra-articular [[Bone fracture|fracture]]


==References==
==References==
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[[Category:Bone fractures]]

Latest revision as of 21:25, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]

Overview

There are multiple classifications available for distal radius fractures. The most common classification systems for distal radius fractures include Frykman, Melone, Fernández, Universal, and AO classification.

Classification

There are multiple classifications available for distal radius fractures. The most common classification systems for distal radius fractures include Frykman (1967), Melone (1984), Fernández (2001), Universal (Cooney 1993), and AO classification (Marsh et al. 2007).

Frykman Classification

Frykman Classification
I Extra-articular
II Extra-articular with ulnar fracture
III Intra-articular into radiocarpal joint
IV Intra-articular into radiocarpal joint with ulnar fracture
V Intra-articular into radioulnar joint
VI Intra-articular into radioulnar joint with ulnar fracture
VII Intra-articular into radiocarpal + radioulnar joints
VIII Intra-articular into radiocarpal + radioulnar joints with ulnar fracture

Melone Classification

Melone Classification
I Undisplaced, no or minimal comminution
II Die punch fracture with moderate to severe displacement
A Reducible
B Irreducible
III Spike fragment present
IV Wide separation of intra-articular fragments
V Explosion fracture with severe comminution, transverse split and rotational displacement

Fernández Classification

Fernández Classification
Type 1 Bending fracture of metaphysis
Type 2 Shearing fracture of joint surface
Type 3 Compression fracture of joint surface
Type 4 Avulsion fractures or radiocarpal fracture-dislocation
Type 5 Combined fractures associated with high high-velocity injuries

Universal Classification

Universal Classification
Type 1 Extra-articular fracture, without deviation
Type 2 Extra-articular fracture, with deviation
2A Reducible and stable
2B Reducible and unstable
2C Irreducible
Type 3 Intra-articular fracture, without deviation
Type 4 Intra-articular fracture, with deviation
4A Reducible and stable
4B Reducible and unstable
4C Irreducible

OTA System

  • AO/ASIF classification is the widely accepted classification.
  • Radius is given the number 21 based on the classification.[6]
  • It is further subdivided as:
OTA System
A Extra-articular fractures
A1 Ulnar fracture, radius intact
A2 Radius fracture, simple and impacted
A3 Radius fracture, multifragmentary
B Partial articular fractures
B1 Radius fracture, sagittal
B2 Radius fracture, frontal, dorsal rim
B3 Radius fracture, frontal, volar rim
C Complete articular fractures
C1 Articular simple + metaphyseal simple
C2 Articular simple, metaphyseal multifragmentary
C3 Articular multifragmentary

Types of Fractures based on Eponyms

Barton's Fracture

  • Fracture-dislocation of radiocarpal joint (with intra-articular fracture involving the volar or dorsal lip)

Chauffer's Fracture

Colles'Fracture

  • Dorsally displaced, extra-articular fracture

Die-punch Fracture

Smith's Fracture

  • Volar displaced, extra-articular fracture

References

  1. ↑ Frykman G (1967). "Fracture of the distal radius including sequelae--shoulder-hand-finger syndrome, disturbance in the distal radio-ulnar joint and impairment of nerve function. A clinical and experimental study". Acta Orthop Scand: Suppl 108:3+. PMID 4175195.
  2. ↑ Melone CP (1993). "Distal radius fractures: patterns of articular fragmentation". Orthop Clin North Am. 24 (2): 239–53. PMID 8479722.
  3. ↑ Melone CP (1984). "Articular fractures of the distal radius". Orthop Clin North Am. 15 (2): 217–36. PMID 6728444.
  4. ↑ Fernandez DL (2001). "Distal radius fracture: the rationale of a classification". Chir Main. 20 (6): 411–25. PMID 11778328.
  5. ↑ Cooney WP (1993). "Fractures of the distal radius. A modern treatment-based classification". Orthop Clin North Am. 24 (2): 211–6. PMID 8479719.
  6. ↑ Arealis G, Galanopoulos I, Nikolaou VS, Lacon A, Ashwood N, Kitsis C (2014). "Does the CT improve inter- and intra-observer agreement for the AO, Fernandez and Universal classification systems for distal radius fractures?". Injury. 45 (10): 1579–84. doi:10.1016/j.injury.2014.06.017. PMID 25042062.

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