Skip to main content

Classification of Long Bone Fractures

  • Reference work entry
  • First Online:
European Surgical Orthopaedics and Traumatology

Abstract

Since human beings acquired speech, they named things. Immanuel Kant thought that the adult human mind naturally organizes its knowledge of the world in groups of objects sharing the same name. The purpose of such organization is to simplify the surrounding world in order to better understand it, communicate with others, and guide actions.

Taxonomy is the science of naming and classifying items, originally concerning only organisms but later extended to the classification of any concept or thing that can be classified. The basic unit is named taxon, and these units are arranged in a hierarchical structure, usually with a type–subtype relationship. The subtype has all the properties of the parent type, plus one or more additional properties characteristic of itself. For example, the living world could be divided into three kingdoms: animals, plants, and bacteria. A mammal is an animal but not all animals are mammals, and a cow is a mammal but not all mammals are cows.

Fracture classification systems based on the same reasoning have probably existed for nearly as long as people have identified fractures. This chapter reviews the concept of fracture classification, with the history, purposes, types, strengths, and limitations of the current classification systems.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 649.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 949.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Linnaeus C. Systema naturae in quo naturae regna tria, secundum classes, ordines, genera, species, systematice proponuntur. Stockholmiae: Kiesewetter Gottfried; 1740.

    Google Scholar 

  2. Woese CR, Kandler O, Wheelis ML. Towards a natural system of organisms: proposal for the domains Archaea, Bacteria, and Eucarya. Proc Natl Acad Sci USA. 1990;87(12):4576–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. MĂĽller ME, Nazarian S, Koch P. The comprehensive classification of fractures of long bones. Berlin/Heidelberg/New York: Springer; 1990.

    Book  Google Scholar 

  4. Breasted JH. The Edwin Smith surgical papyrus: hieroglyphic transliteration, translation and commentary V1. Whitefish: Kessinger Publishing; 2006.

    Google Scholar 

  5. Hippocrates. On fractures. Whitefish: Kessinger Publishing; 2004.

    Google Scholar 

  6. Celsus AC. Cure générale de la fracture du bras, de l’avant-bras, de la cuisse, de la jambe et des doigts. In Traité de médecine de Celse, d’après l’édition de Léonard Targa. Paris: Imprimerie de Béthune et Plon; 1838.

    Google Scholar 

  7. Pott P. Some few general remarks on fractures and dislocations. London: Hawes, Clarke, Collins; 1765.

    Google Scholar 

  8. Peltier LF. Eponymic fractures: Giovanni Battista Monteggia and Monteggia's fracture. Surgery. 1957;42(3):585–91.

    CAS  PubMed  Google Scholar 

  9. Colles A. On the fracture of the carpal extremity of the radius. Edinb Med Surg J. 1814;10:182–6.

    Google Scholar 

  10. Schepers T, van Lieshout EM, Ginai AZ, Mulder PG, Heetveld MJ, Patka P. Calcaneal fracture classification: a comparative study. J Foot Ankle Surg. 2009;48(2):156–62.

    Article  PubMed  Google Scholar 

  11. Garden RS. Low angle fixation in fractures of the femoral neck. J Bone Joint Surg Br. 1961;43:647–63.

    Google Scholar 

  12. Neer 2nd CS. Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am. 1970;52(6):1077–89.

    PubMed  Google Scholar 

  13. Sanders R, Fortin P, DiPasquale T, Walling A. Operative treatment in 120 displaced intraarticular calcaneal fractures. Results using a prognostic computed tomography scan classification. Clin Orthop Relat Res. 1993;290:87–95.

    PubMed  Google Scholar 

  14. Zwipp H, Tscherne H, Wulker N, Grote R. Intra-articular fracture of the calcaneus. Classification, assessment and surgical procedures. Unfallchirurg. 1989;92(3):117–29.

    CAS  PubMed  Google Scholar 

  15. Dirschl DR, Dawson PA. Injury severity assessment in tibial plateau fractures. Clin Orthop Relat Res. 2004;423:85–92.

    Article  PubMed  Google Scholar 

  16. Marsh JL, Buckwalter J, Gelberman R, Dirschl D, Olson S, Brown T, et al. Articular fractures: does an anatomic reduction really change the result? J Bone Joint Surg Am. 2002;84-A(7):1259–71.

    CAS  PubMed  Google Scholar 

  17. Oakes DA, Jackson KR, Davies MR, Ehrhart KM, Zohman GL, Koval KJ, et al. The impact of the garden classification on proposed operative treatment. Clin Orthop Relat Res. 2003;409:232–40.

    Article  PubMed  Google Scholar 

  18. Swiontkowski MF, Agel J, McAndrew MP, Burgess AR, MacKenzie EJ. Outcome validation of the AO/OTA fracture classification system. J Orthop Trauma. 2000;14(8):534–41.

    Article  CAS  PubMed  Google Scholar 

  19. Burstein AH. Fracture classification systems: do they work and are they useful? J Bone Joint Surg Am. 1993;75(12):1743–4.

    CAS  PubMed  Google Scholar 

  20. Schatzker J. Compression in the surgical treatment of fractures of the tibia. Clin Orthop Relat Res. 1974;105:220–39.

    Article  PubMed  Google Scholar 

  21. Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968–1975. Clin Orthop Relat Res. 1979;138:94–104.

    PubMed  Google Scholar 

  22. Weber BG. Die Verletzungen des oberen sprunggelenkes. Bern: Huber Verlag; 1972.

    Google Scholar 

  23. Duncan CP, Masri BA. Fractures of the femur after hip replacement. Instr Course Lect. 1995;44:293–304.

    CAS  PubMed  Google Scholar 

  24. Salter RB, Harris WR. Injuries involving the epiphyseal plate. J Bone Joint Surg Am. 1963;45:587–622.

    Google Scholar 

  25. Mirels H. Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures. Clin Orthop Relat Res. 1989;249:256–64.

    PubMed  Google Scholar 

  26. Kellam JF, Audigé L. Fracture Classification. In: Rüedi TP, Buckley RE, Moran CG, editors. AO principles of fracture management. Switzerland: AO Publishing; 2007. p. 69–85.

    Google Scholar 

  27. Fracture and dislocation compendium. Orthopaedic Trauma Association Committee for Coding and Classification. J Orthop Trauma. 1996;10 Suppl 1:v–ix, 1–154.

    Google Scholar 

  28. Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976;58(4):453–8.

    CAS  PubMed  Google Scholar 

  29. Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma. 1984;24(8):742–6.

    Article  CAS  PubMed  Google Scholar 

  30. Tscherne H, Gotzen L. Fractures with soft tissue injuries. Berlin/Heidelberg/New York: Springer; 1984.

    Book  Google Scholar 

  31. Südkamp NP, The AO. soft-tissue grading system. In: Rüedi TP, Buckley RE, Moran CG, editors. AO principles of fracture management. Switzerland: AO Publishing; 2009. p. 99–112.

    Google Scholar 

  32. Masquelet AC, de Haas W. The problem of classifying soft-tissue lesions. In: Rüedi TP, Buckley RE, Moran CG, editors. AO principles of fracture management. Switzerland: AO Publishing; 2007. p. 373–4.

    Google Scholar 

  33. Audige L, Bhandari M, Hanson B, Kellam J. A concept for the validation of fracture classifications. J Orthop Trauma. 2005;19(6):401–6.

    PubMed  Google Scholar 

  34. Garbuz DS, Masri BA, Esdaile J, Duncan CP. Classification systems in orthopaedics. J Am Acad Orthop Surg. 2002;10(4):290–7.

    PubMed  Google Scholar 

  35. Malek IA, Machani B, Mevcha AM, Hyder NH. Inter-observer reliability and intra-observer reproducibility of the Weber classification of ankle fractures. J Bone Joint Surg Br. 2006;88(9):1204–6.

    Article  CAS  PubMed  Google Scholar 

  36. Walton NP, Harish S, Roberts C, Blundell C. AO or Schatzker? How reliable is classification of tibial plateau fractures? Arch Orthop Trauma Surg. 2003;123(8):396–8.

    Article  CAS  PubMed  Google Scholar 

  37. Martin JS, Marsh JL. Current classification of fractures. Rationale and utility. Radiol Clin North Am. 1997;35(3):491–506.

    CAS  PubMed  Google Scholar 

  38. Maripuri SN, Rao P, Manoj-Thomas A, Mohanty K. The classification systems for tibial plateau fractures: how reliable are they? Injury. 2008;39(10):1216–21.

    Article  PubMed  Google Scholar 

  39. Chan PS, Klimkiewicz JJ, Luchetti WT, Esterhai JL, Kneeland JB, Dalinka MK, et al. Impact of CT scan on treatment plan and fracture classification of tibial plateau fractures. J Orthop Trauma. 1997;11(7):484–9.

    Article  CAS  PubMed  Google Scholar 

  40. Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960;20:37–46.

    Article  Google Scholar 

  41. Martin J, Marsh JL, Nepola JV, Dirschl DR, Hurwitz S, DeCoster TA. Radiographic fracture assessments: which ones can we reliably make? J Orthop Trauma. 2000;14(6):379–85.

    Article  CAS  PubMed  Google Scholar 

  42. Fleiss JL. Statistical methods for rates and proportions. New York: Wiley-Interscience; 1981.

    Google Scholar 

  43. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–74.

    Article  CAS  PubMed  Google Scholar 

  44. Svanholm H, Starklint H, Gundersen HJ, Fabricius J, Barlebo H, Olsen S. Reproducibility of histomorphologic diagnoses with special reference to the kappa statistic. APMIS. 1989;97(8):689–98.

    Article  CAS  PubMed  Google Scholar 

  45. Petrie A, Sabin C. Assessing agreement. In Medical statistics at a glance. Oxford: Blackwell; 2005. p. 105–7.

    Google Scholar 

  46. Rayan F, Dodd M, Haddad FS. European validation of the Vancouver classification of periprosthetic proximal femoral fractures. J Bone Joint Surg Br. 2008;90(12):1576–9.

    Article  CAS  PubMed  Google Scholar 

  47. Beaule PE, Dorey FJ, Matta JM. Letournel classification for acetabular fractures. Assessment of interobserver and intraobserver reliability. J Bone Joint Surg Am. 2003;85-A(9):1704–9.

    PubMed  Google Scholar 

  48. Ploegmakers JJ, Mader K, Pennig D, Verheyen CC. Four distal radial fracture classification systems tested amongst a large panel of Dutch trauma surgeons. Injury. 2007;38(11):1268–72.

    Article  PubMed  Google Scholar 

  49. Belloti JC, Tamaoki MJ, Franciozi CE, Santos JB, Balbachevsky D, Chap Chap E, Albertoni WM, Faloppa F. Are distal radius fracture classifications reproducible? Intra and interobserver agreement. Sao Paulo Med J. 2008;126(3):180–5.

    Google Scholar 

  50. Sheps DM, Kiefer KR, Boorman RS, Donaghy J, Lalani A, Walker R, et al. The interobserver reliability of classification systems for radial head fractures: the Hotchkiss modification of the Mason classification and the AO classification systems. Can J Surg. 2009;52(4):277–82.

    PubMed Central  PubMed  Google Scholar 

  51. Morgan SJ, Groshen SL, Itamura JM, Shankwiler J, Brien WW, Kuschner SH. Reliability evaluation of classifying radial head fractures by the system of Mason. Bull Hosp Jt Dis. 1997;56(2):95–8.

    CAS  PubMed  Google Scholar 

  52. Fung W, Jonsson A, Buhren V, Bhandari M. Classifying intertrochanteric fractures of the proximal femur: does experience matter? Med Princ Pract. 2007;16(3):198–202.

    Article  PubMed  Google Scholar 

  53. Jin WJ, Dai LY, Cui YM, Zhou Q, Jiang LS, Lu H. Reliability of classification systems for intertrochanteric fractures of the proximal femur in experienced orthopaedic surgeons. Injury. 2005;36(7):858–61.

    Article  PubMed  Google Scholar 

  54. van Embden D, Rhemrev SJ, Meylaerts SA, Roukema GR. The comparison of two classifications for trochanteric femur fractures: the AO/ASIF classification and the Jensen classification. Injury. 2010;41(4):377–81.

    Article  PubMed  Google Scholar 

  55. Beimers L, Kreder HJ, Berry GK, Stephen DJ, Schemitsch EH, McKee MD, et al. Subcapital hip fractures: the Garden classification should be replaced, not collapsed. Can J Surg. 2002;45(6):411–4.

    PubMed Central  PubMed  Google Scholar 

  56. Brunner A, Honigmann P, Treumann T, Babst R. The impact of stereo-visualisation of three-dimensional CT datasets on the inter- and intraobserver reliability of the AO/OTA and Neer classifications in the assessment of fractures of the proximal humerus. J Bone Joint Surg Br. 2009;91(6):766–71.

    Article  CAS  PubMed  Google Scholar 

  57. Martin JS, Marsh JL, Bonar SK, DeCoster TA, Found EM, Brandser EA. Assessment of the AO/ASIF fracture classification for the distal tibia. J Orthop Trauma. 1997;11(7):477–83.

    Article  CAS  PubMed  Google Scholar 

  58. Johnstone DJ, Radford WJ, Parnell EJ. Interobserver variation using the AO/ASIF classification of long bone fractures. Injury. 1993;24(3):163–5.

    Article  CAS  PubMed  Google Scholar 

  59. Dirschl DR, Adams GL. A critical assessment of factors influencing reliability in the classification of fractures, using fractures of the tibial plafond as a model. J Orthop Trauma. 1997;11(7):471–6.

    Article  CAS  PubMed  Google Scholar 

  60. Bernstein J, Adler LM, Blank JE, Dalsey RM, Williams GR, Iannotti JP. Evaluation of the Neer system of classification of proximal humeral fractures with computerized tomographic scans and plain radiographs. J Bone Joint Surg Am. 1996;78(9):1371–5.

    CAS  PubMed  Google Scholar 

  61. Humphrey CA, Dirschl DR, Ellis TJ. Interobserver reliability of a CT-based fracture classification system. J Orthop Trauma. 2005;19(9):616–22.

    Article  PubMed  Google Scholar 

  62. Sjoden GO, Movin T, Guntner P, Aspelin P, Ahrengart L, Ersmark H, et al. Poor reproducibility of classification of proximal humeral fractures. Additional CT of minor value. Acta Orthop Scand. 1997;68(3):239–42.

    Article  CAS  PubMed  Google Scholar 

  63. Harness NG, Ring D, Zurakowski D, Harris GJ, Jupiter JB. The influence of three-dimensional computed tomography reconstructions on the characterization and treatment of distal radial fractures. J Bone Joint Surg Am. 2006;88(6):1315–23.

    Article  PubMed  Google Scholar 

  64. Borrelli Jr J, Goldfarb C, Catalano L, Evanoff BA. Assessment of articular fragment displacement in acetabular fractures: a comparison of computerized tomography and plain radiographs. J Orthop Trauma. 2002;16(7):449–56. discussion 456–7.

    Article  PubMed  Google Scholar 

  65. Cole RJ, Bindra RR, Evanoff BA, Gilula LA, Yamaguchi K, Gelberman RH. Radiographic evaluation of osseous displacement following intra-articular fractures of the distal radius: reliability of plain radiography versus computed tomography. J Hand Surg Am. 1997;22(5):792–800.

    Article  CAS  PubMed  Google Scholar 

  66. Katz MA, Beredjiklian PK, Bozentka DJ, Steinberg DR. Computed tomography scanning of intra-articular distal radius fractures: does it influence treatment? J Hand Surg Am. 2001;26(3):415–21.

    Article  CAS  PubMed  Google Scholar 

  67. Hu YL, Ye FG, Ji AY, Qiao GX, Liu HF. Three-dimensional computed tomography imaging increases the reliability of classification systems for tibial plateau fractures. Injury. 2009;40(12):1282–5.

    Article  PubMed  Google Scholar 

  68. Doornberg J, Lindenhovius A, Kloen P, van Dijk CN, Zurakowski D, Ring D. Two and three-dimensional computed tomography for the classification and management of distal humeral fractures. Evaluation of reliability and diagnostic accuracy. J Bone Joint Surg Am. 2006;88(8):1795–801.

    Article  PubMed  Google Scholar 

  69. Sjoden GO, Movin T, Aspelin P, Guntner P, Shalabi A. 3D-radiographic analysis does not improve the Neer and AO classifications of proximal humeral fractures. Acta Orthop Scand. 1999;70(4):325–8.

    Article  CAS  PubMed  Google Scholar 

  70. Sanders RW. The Problem with Apples and Oranges. J Orthop Trauma. 1997;7:465–6.

    Article  Google Scholar 

  71. Swiontkowski MF, Sands AK, Agel J, Diab M, Schwappach JR, Kreder HJ. Interobserver variation in the AO/OTA fracture classification system for pilon fractures: is there a problem? J Orthop Trauma. 1997;11(7):467–70.

    Article  CAS  PubMed  Google Scholar 

  72. Craig 3rd WL, Dirschl DR. Effects of binary decision making on the classification of fractures of the ankle. J Orthop Trauma. 1998;12(4):280–3.

    Article  PubMed  Google Scholar 

  73. Bernstein J, Monaghan BA, Silber JS, DeLong WG. Taxonomy and treatment–a classification of fracture classifications. J Bone Joint Surg Br. 1997;79(5):706–7. discussion 708–9.

    Article  CAS  PubMed  Google Scholar 

  74. Colton CL. Fracture classification: A response to Bernstein et al. J Bone Joint Surg Br. 1997;79:708–9.

    Google Scholar 

  75. Audigé L, Bhandari M, Kellam J. How reliable are reliability studies of fracture classifications? A systematic review of their methodologies. Acta Orthop Scand. 2004;75(2):184–94.

    Article  PubMed  Google Scholar 

  76. Smith RM. The classification of fractures. J Bone Joint Surg Br. 2000;82(5):625–6.

    Article  CAS  PubMed  Google Scholar 

  77. El-Husseiny M, Coleman N. Inter- and intra-observer variation in classification systems for impending fractures of bone metastases. Skeletal Radiol. 2010;39(2):155–60.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2014 EFORT

About this entry

Cite this entry

Fleury, T.R., Stern, R. (2014). Classification of Long Bone Fractures. In: Bentley, G. (eds) European Surgical Orthopaedics and Traumatology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-34746-7_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-34746-7_5

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-34745-0

  • Online ISBN: 978-3-642-34746-7

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics