Distal radius fracture classification: Difference between revisions

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==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).<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><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><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><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="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>
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).<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><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><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><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="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><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>


===Frykman Classification===
===Frykman Classification===
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===OTA System===
*AO/ASIF  classification is the widely accepted classification
*Radius is given the number 21 based on the classification
*It is further subdivided as:
 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




===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]].)
* (21-A) Extra-articular
** (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





Revision as of 21:57, 12 December 2018

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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. (Marsh et al. 2007).

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).[1][2][3][4][5][6]

Frykman Classification

  • Frykman classified distal radius fracture based on Location
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
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 classified distal radius fracture based on trauma mechanism
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

  • Cooney classified distal radius fracture based on location ans stability
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
  • It is further subdivided as:

 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



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. Fernandez DL (2001). "Distal radius fracture: the rationale of a classification". Chir Main. 20 (6): 411–25. PMID 11778328.
  3. Melone CP (1984). "Articular fractures of the distal radius". Orthop Clin North Am. 15 (2): 217–36. PMID 6728444.
  4. Melone CP (1993). "Distal radius fractures: patterns of articular fragmentation". Orthop Clin North Am. 24 (2): 239–53. PMID 8479722.
  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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