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Journal articles on the topic 'Fracture classification'
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Kijima, Hiroaki, Shin Yamada, Natsuo Konishi, Hitoshi Kubota, Hiroshi Tazawa, Takayuki Tani, Norio Suzuki, et al. "The Reliability of Classifications of Proximal Femoral Fractures with 3-Dimensional Computed Tomography: The New Concept of Comprehensive Classification." Advances in Orthopedics 2014 (2014): 1–5. http://dx.doi.org/10.1155/2014/359689.
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The reliability of proximal femoral fracture classifications using 3DCT was evaluated, and a comprehensive “area classification” was developed. Eleven orthopedists (5–26 years from graduation) classified 27 proximal femoral fractures at one hospital from June 2013 to July 2014 based on preoperative images. Various classifications were compared to “area classification.” In “area classification,” the proximal femur is divided into 4 areas with 3 boundary lines: Line-1 is the center of the neck, Line-2 is the border between the neck and the trochanteric zone, and Line-3 links the inferior borders of the greater and lesser trochanters. A fracture only in the first area was classified as a pure first area fracture; one in the first and second area was classified as a 1-2 type fracture. In the same way, fractures were classified as pure 2, 3-4, 1-2-3, and so on. “Area classification” reliability was highest when orthopedists with varying experience classified proximal femoral fractures using 3DCT. Other classifications cannot classify proximal femoral fractures if they exceed each classification’s particular zones. However, fractures that exceed the target zones are “dangerous” fractures. “Area classification” can classify such fractures, and it is therefore useful for selecting osteosynthesis methods.
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van Heerden, Frans G., Robert M. Kirberger, and Marthinus J. Hartman. "Long Bone Fractures in Impala (Aepyceros melampus): A Classification System and Review of 55 Cases." Veterinary and Comparative Orthopaedics and Traumatology 32, no. 05 (June 3, 2019): 408–19. http://dx.doi.org/10.1055/s-0039-1691818.
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Abstract Objective The purpose of this study was to introduce a modified-Unger fracture classification in impala and report the findings of 58 long bone fractures classified according to this system. Methods This was a retrospective radiographical study evaluating 122 radiographs of 58 long bone fractures in 55 impala. The Unger fracture classification was modified and fracture illustrations for the metacarpal and metatarsal bones added. Each fracture was classified and assigned a four symbol α-numeric code using our classification. The patient signalment, skeletal maturity, fracture-associated soft tissue changes, presence of fissure lines, periosteal reaction and cause of the fracture were recorded. Results The overall fracture distribution based on location, found tibial (n = 17) fractures to be the most common fractured long bone. When combined, the majority of fractures involved the metacarpal and metatarsal bones (n = 23). Forty five of 58 fractures occurred in the diaphyseal bone segment. In all long bones, the distribution based on complexity was simple (n = 27), wedge (n = 16) and multi-fragmentary (n = 15) fractures. Thirty one of 58 fractures were open and fissure lines were detected in 20 of 58 fractures. Clinical Significance Our modified-Unger fracture classification was applicable in classifying 58 impala long bone fractures. This classification should provide the basis for further advances in veterinary and comparative ungulates, and particularly the antelopes, orthopaedics and traumatology.
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Drijkoningen, Tessa, Amin Mohamadi, Wouter F. van Leeuwen, Yonatan Schwarcz, David Ring, and Geert A. Buijze. "Scaphoid Fracture Patterns—Part Two: Reproducibility and Demographics of a Simplified Scaphoid Fracture Classification." Journal of Wrist Surgery 08, no. 06 (July 12, 2019): 446–51. http://dx.doi.org/10.1055/s-0039-1692470.
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Abstract Objective To analyze the reproducibility, reliability, and demographics of a simplified anatomical scaphoid fracture classification based on posteroanterior radiographs using a large database of scaphoid fractures. Methods The study consisted of a retrospective review of electronic medical records of 871 consecutive patients. All patients presented between 2003 and 2014 at two centers. Patient- and surgeon-related factors were analyzed. Additionally, interobserver reliability of the Herbert and simplified scaphoid fracture classifications were tested. Results Proximal pole fractures were defined as fractures in which the center of the fracture line was proximal to the distal scapholunate interval (n = 30), waist fractures (n = 802) were defined as fractures involving the scaphocapitate interval, and distal tubercle fractures (n = 39) were defined as fractures involving the scaphotrapeziotrapezoid (STT) interval. The interobserver reliability of the simplified classification was fair (κ = 0.37) as for the Herbert classification (κ = 0.31). The average doubt of the answers of the observers was 2.1 on a scale from 0 to 10 for the simplified classification and 3.6 for the Herbert classification (P < 0.05). Conclusions All complete fractures across the entire scaphoid distal to the scapholunate articulation and proximal to the STT joint can be classified as waist fractures; nonwaist scaphoid fractures are uncommon (6%) and have somewhat different presentations compared to waist fractures. Simplifying the fracture classification slightly improves interobserver reliability, although remaining fair, and significantly reduces doubt. Level of Evidence This is a Level III, prognostic study.
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Unger, M., P. M. Montavon, and U. F. A. Heim. "Classification of Fractures of Long Bones in the Dog and Cat: Introduction and Clinical Application." Veterinary and Comparative Orthopaedics and Traumatology 03, no. 02 (1990): 41–50. http://dx.doi.org/10.1055/s-0038-1633228.
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AbstractA computer filing system for the classification of fractured long bones in dogs and cats is described. It includes definitions of terms and a method of classification, based on fracture criteria seen on radiographs. This fracture classification was adapted from the AO/ASIF classification in man, to accomodate the special requirements of small animals. The localization and morphology of fractures were characterized with defined conventional terms, in order to assign an alpha-numeric code to each fracture. This coding system may also be used for computer filing of the data. With this classification system, the fractures are ranked in increasing severity and complexity for the various anatomical locations. This provides some prognostic and therapeutic informations. The system was used to code 1038 radiographically documented long bone fractures in dogs and cats. The distribution of fractures, with regard to their localization and morphology, was recorded. The system was easy to apply and proved to be able to supply valuable and reliable data.A computer filing system for the classification of fractured long bones in dogs and cats is described.
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Teng, Yugang, Yuanzhen Zhang, and Zhenyu Wang. "Medical Image Analysis and Correlation Between Ankle Fracture Classification and Ankle Computed Tomography." Journal of Medical Imaging and Health Informatics 10, no. 12 (December 1, 2020): 2935–39. http://dx.doi.org/10.1166/jmihi.2020.3235.
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Objective: In this paper, we summarize computed tomography (CT) manifestations and characteristics of ankle fractures, and analyze the relationship between CT images and common ankle fracture classifications. Methods: A retrospective survey of 369 adult ankle fractures was performed. CT images of 1 cm horizontal cross-section above the ankle points and their characteristics were analyzed. Ankle fracture X-ray classification was performed, and the relationship between CT images and fracture X-ray classification was analyzed. Results: There is a correlation between CT images and Danis-Weber classification. The incidence of IOL fractures varies with the severity of Danis-Weber classification. After rank correlation test, the difference is statistically significant (Spearman R = 0.781,P < 0.001). CT images can detect IOL fractures that cannot be judged by X-ray fracture classification, and the incidence rate is 5.9%. Conclusions: The 1 cm horizontal cross-section CT image on the ankle point can clearly determine the combined tibiofibular IOL injury before surgery, and it has a good correlation with the Danis-Weber fracture classification, and can detect unexplainable IOL fractures in some radiographs.
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Shoda, Etsuo, Shimpei Kitada, Yu Sasaki, Hitoshi Hirase, Takahiro Niikura, Sang Yang Lee, Atsushi Sakurai, Keisuke Oe, and Takeharu Sasaki. "Proposal of new classification of femoral trochanteric fracture by three-dimensional computed tomography and relationship to usual plain X-ray classification." Journal of Orthopaedic Surgery 25, no. 1 (January 1, 2017): 230949901769270. http://dx.doi.org/10.1177/2309499017692700.
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Purpose: Classification of femoral trochanteric fractures is usually based on plain X-ray findings using the Evans, Jensen, or AO/OTA classification. However, complications such as nonunion and cut out of the lag screw or blade are seen even in stable fracture. This may be due to the difficulty of exact diagnosis of fracture pattern in plain X-ray. Computed tomography (CT) may provide more information about the fracture pattern, but such data are scarce. In the present study, it was performed to propose a classification system for femoral trochanteric fractures using three-dimensional CT (3D-CT) and investigate the relationship between this classification and conventional plain X-ray classification. Methods: Using three-dimensional (3D)-CT, fractures were classified as two, three, or four parts using combinations of the head, greater trochanter, lesser trochanter, and shaft. We identified five subgroups of three-part fractures according to the fracture pattern involving the greater and lesser trochanters. In total, 239 femoral trochanteric fractures (45 men, 194 women; average age, 84.4 years) treated in four hospitals were classified using our 3D-CT classification. The relationship between this 3D-CT classification and the AO/OTA, Evans, and Jensen X-ray classifications was investigated. Results: In the 3D-CT classification, many fractures exhibited a large oblique fragment of the greater trochanter including the lesser trochanter. This fracture type was recognized as unstable in the 3D-CT classification but was often classified as stable in each X-ray classification. Conclusions: It is difficult to evaluate fracture patterns involving the greater trochanter, especially large oblique fragments including the lesser trochanter, using plain X-rays. The 3D-CT shows the fracture line very clearly, making it easy to classify the fracture pattern.
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Michelson, James, and John Delaney. "Ankle Fracture Stability-based Classification." Foot & Ankle Orthopaedics 3, no. 3 (July 1, 2018): 2473011418S0034. http://dx.doi.org/10.1177/2473011418s00348.
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Category: Trauma Introduction/Purpose: Rotational ankle fractures are common in orthopaedic surgery, however existing classification systems are mostly descriptive in nature and do not explicitly guide surgical decision-making. A Stability-Based classification was developed recently to provide a more prognostic classification. The purpose of this study was to compare the reproducibility of existing ankle fracture classifications, and determine the ability of the Stability-Based classification to predict clinical treatment. Methods: One hundred ninety-three consecutive ankle fractures treated at our institution were retrospectively analyzed. Rotational type injury patterns in patients >18 years old were included. None of the subjects were clinically treated or evaluated by the study authors. The fractures were treated by attending physicians who were unaware of the Stability-Based classification system. Pathologic fractures were excluded. Three observers classified injury radiographs using the Lauge-Hansen, Weber/AO, and Stability-Based classifications systems. Reproducibility (inter-observer variation) of each classification system was calculated using kappa statistics. Prognostic values were evaluated by calculating the area under the curve (AUC) for the ROC curves (using surgery as the positive outcome) for each classification. Results: The Stability-Based classification was showed the excellent reproducibility (kappa .938, 95% CI .921-.952), along with the Weber/AO classification (kappa .97, 95% CI .961-.976), while the Lauge-Hansen had the lowest reproducibility (kappa .74, 95%CI .664-.795). The AUC for the three classifications were .883 (95%CI .852-.914), .626 (95%CI .576-.675), and .698 (95%CI .641-.755), respectively (Figure 1). The AUC was significantly better for the Stability-Based classification compared to the other 2 classifications (p<.001). Conclusion: The AO/Weber classification had excellent reproducibility, but did not predict the need for surgical stabilization accurately. In contrast, the Stability-Based classification system was both highly reproducible (kappa .938) with excellent prognostic ability to identify patients who got surgery (AUC .883). Furthermore, there were no patients who were classified as stable who failed non-operative treatment. The Stability-Based classification was found to have superior prognostic capacity compared to both the Lauge-Hansen and AO/Weber classification systems. This extends earlier studies by showing the reproducibility of the Stability-Based classification system and directly demonstrating its prognostic superiority to other classification systems.
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Liu, Yijun, Hao Lu, Hailin Xu, Wenyong Xie, Xiaokun Chen, Zhongguo Fu, Dianying Zhang, and Baoguo Jiang. "Characteristics and classification of medial malleolar fractures." Bone & Joint Journal 103-B, no. 5 (May 1, 2021): 931–38. http://dx.doi.org/10.1302/0301-620x.103b5.bjj-2020-1859.r2.
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Aims The morphology of medial malleolar fracture is highly variable and difficult to characterize without 3D reconstruction. There is also no universally accepeted classification system. Thus, we aimed to characterize fracture patterns of the medial malleolus and propose a classification scheme based on 3D CT reconstruction. Methods We retrospectively reviewed 537 consecutive cases of ankle fractures involving the medial malleolus treated in our institution. 3D fracture maps were produced by superimposing all the fracture lines onto a standard template. We sliced fracture fragments and the standard template based on selected sagittal and coronal planes to create 2D fracture maps, where angles α and β were measured. Angles α and β were defined as the acute angles formed by the fracture line and the horizontal line on the selected planes. Results A total of 121 ankle fractures were included. We revealed several important fracture features, such as a high correlation between posterior collicular fractures and posteromedial fragments. Moreover, we generalized the fracture geometry into three recurrent patterns on the coronal view of 3D maps (transverse, vertical, and irregular) and five recurrent patterns on the lateral view (transverse, oblique, vertical, Y-shaped, and irregular). According to the fracture geometry on the coronal and lateral view of 3D maps, we subsequently categorized medial malleolar fractures into six types based on the recurrent patterns: anterior collicular fracture (27 type I, 22.3%), posterior collicular fracture (12 type II, 9.9%), concurrent fracture of anterior and posterior colliculus (16 type III, 13.2%), and supra-intercollicular groove fracture (66 type IV, 54.5%). Therewere three variants of type IV fractures: transverse (type IVa), vertical (type IVb), and comminuted fracture (type IVc). The angles α and β varied accordingly. Conclusion Our findings yield insight into the characteristics and recurrent patterns of medial malleolar fractures. The proposed classification system is helpful in understanding injury mechanisms and guiding diagnosis, as well as surgical strategies. Cite this article: Bone Joint J 2021;103-B(5):931–938.
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Colton, C. L. "Fracture classification." Journal of Bone and Joint Surgery. British volume 79-B, no. 5 (September 1997): 708–9. http://dx.doi.org/10.1302/0301-620x.79b5.0790708.
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Tabakovic, Dejan, Radovan Manojlovic, Marko Kadija, Mihailo Ille, Goran Turkovic, and Zoran Vukasinovic. "Possible factors for ankle fractures." Vojnosanitetski pregled 67, no. 3 (2010): 225–28. http://dx.doi.org/10.2298/vsp1003225t.
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Background/Aim. Classification of ankle fractures is commonly used for selecting an appropriate treatment and prognosing an outcome of definite management. One of the most used classifications is the Danis-Weber classification. To the best of our knowledge, in the available literature, there are no parameters affecting specific types of ankle fractures according to the Danis-Weber classification. The aim of this study was to analyze the correlation of the following parameters: age, body weight, body mass index (BMI), height, osteoporosis, osteopenia and physical exercises with specific types of ankle fractures using the Danis-Weber classification. Methods. A total of 85 patients grouped by the Danis-Weber classification fracture types were analyzed and the significance of certain parameters for specific types of ankle fractures was established. Results. The proportion of females was significantly higher (p < 0.001) with a significantly higher age (59.9 years, SD ? 14.2) in relation to males (45.1 years, SD ? 12.8) (p < 0.0001). Type A fracture was most frequent in the younger patients (34.2 years, SD ? 8.6), and those with increased physical exercises (p = 0.020). In type B fracture, the risk factor was osteoporosis (p = 0.0180), while in type C fracture, body weight (p = 0.017) and osteoporosis (p = 0.004) were significant parameters. Conclusion. Statistical analysis using the Danis-Weber classification reveals that there are certain parameters suggesting significant risk factors for specific types of ankle fractures.
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Acosta Hospitaleche, Carolina, Leandro M. Perez, Walter Acosta, and Marcelo Reguero. "A traumatic fracture in a giant Eocene penguin from Antarctica." Antarctic Science 24, no. 6 (July 4, 2012): 619–24. http://dx.doi.org/10.1017/s0954102012000430.
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AbstractA fractured femur of a giant fossil penguin from the Anthropornis nordenskjoeldi Biozone (Late Eocene), Isla Marambio (Seymour Island), Antarctica (La Meseta Formation) is described. Palaeoecological, palaeopathological and taphonomical implications derived from the analysis of the kinds of fractures identified are also discussed. The main fracture has irregular margins, indicating there was collagen in the bone at the time of the impact. In this fracture, a mineral deposit was also identified as a fracture hematoma. According to the antemortem classification of fractures, it was produced by an indirect mechanism, provocating a “butterfly wing” or “third fragment” fracture. The remaining fractures are assigned to times of biostratinomic and fossil diagenesis.
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Agarwal, Padmanidhi, and Divya Mehrotra. "Mandibular Ramus Fractures: A Proposed Classification." Craniomaxillofacial Trauma & Reconstruction 13, no. 1 (February 10, 2020): 9–14. http://dx.doi.org/10.1177/1943387520903159.
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Aims: The purpose of this article was to study and devise a classification of fracture patterns of the mandibular ramus to facilitate management. Methods: Mandibular ramus fracture demographics in literature were reviewed along with evaluation of the patients diagnosed with mandibular ramus fractures who had reported to the emergency/outpatient clinic of our Institute in the last 5 years. Epidemiology of these ramus fractures was studied, and these ramus fractures were categorized into repetitive patterns on the basis of radiological observations in an effort to achieve a simplified classification. Results: A total of 1372 trauma patients were diagnosed with mandibular fractures, of which an incidence of 2.4% was recorded for ramus fractures. These were predominantly in males and mainly due to road traffic accidents commonly in people driving two-wheeler vehicles (64%). Ramus fractures seldom occur in isolation. Five predictable fracture patterns were observed and accordingly classified as types I to V. Type I was the most common and type IV the least. Open reduction was done in 45.5% patients with non-compression plating systems. Satisfactory aesthetic and functional outcomes were achieved in all patients. Conclusion: The mandibular ramus fractures although rare need to be well understood and demarcated. The classification highlights the importance of this mandibular buttress and focuses on the importance of its technically and anatomically more complicated fracture treatment. Future studies are needed to compare the modalities of management.
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Zhao, Zhenhua, Yiming Lyu, Tim Leschinger, Kilian Wegmann, Lars Peter Müller, and Michael Hackl. "Imaging diagnosis of radial head fractures—evaluation of plain radiography vs. CT scans." Obere Extremität 16, no. 3 (May 3, 2021): 198–202. http://dx.doi.org/10.1007/s11678-021-00642-z.
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Abstract Background Radial head fractures represent a common pathology that can cause permanent disability, especially if not treated correctly. Plain radiographs as well as computed tomography (CT) scans represent important diagnostic measures. The specific differences between these two imaging modalities with regard to diagnosis of radial head fractures have not been evaluated to date. Objective This study aimed to compare estimations of fracture classification, percentage of articular fracture involvement, and fragment sizes through plain radiography with CT scan evaluations. Methods A total of 52 consecutive cases of isolated radial head fractures with plain radiographs and CT scans were evaluated retrospectively. Two observers analyzed the fracture classification according to Mason, the percentage of articular fracture involvement, and the size of the largest fracture fragment by means of CT. Three trauma surgeons estimated these parameters through blinded plain radiographs. Intra- and inter-observer reliability were evaluated. Results The CT scan evaluations showed high intra- and inter-observer reliability without significant differences between the two observers. X‑ray estimations of fracture classifications showed only fair agreements. Moreover, the estimations of articular fracture involvement and fragment sizes differed significantly from the CT scan evaluations. While the fragment size tended to be underrated, the articular involvement tended to be overrated. Conclusion This study shows that plain radiographs often provide unreliable information regarding classification, articular involvement, and fragment sizes of radial head fractures. When in doubt, an additional CT scan should be carried out to assess the injury in greater detail.
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Szwebel, J. D., V. Ehlinger, V. Pinsolle, P. Bruneteau, P. Pélissier, and L. R. Salmi. "Reliability of a Classification of Fractures of the Hand Based On the AO Comprehensive Classification System." Journal of Hand Surgery (European Volume) 35, no. 5 (June 2010): 392–95. http://dx.doi.org/10.1177/1753193409355256.
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The AO/ASIF Comprehensive Classification of Fractures is a logical system to describe and compare long-bone fractures. We adapted this classification to the hand to classify fractures of the metacarpals and phalanges. The alphanumeric sequence codes the bone involved, the bone segment, and the fracture type. To assess the reliability of this classification, one hundred radiographs of hand fractures were classified by nine observers in four sessions. Using Cohen’s kappa coefficient, overall inter-observer agreement was 0.93 for bone identification, 0.80 for bone segment, and 0.44 for fracture type. Corresponding intra-observer agreement was 0.94, 0.92 and 0.62 respectively.
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Teo, T. L., E. K. Schaeffer, E. Habib, A. Cherukupalli, A. P. Cooper, A. Aroojis, W. N. Sankar, et al. "Assessing the reliability of the modified Gartland classification system for extension-type supracondylar humerus fractures." Journal of Children's Orthopaedics 13, no. 6 (December 1, 2019): 569–74. http://dx.doi.org/10.1302/1863-2548.13.190005.
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Purpose The Gartland extension-type supracondylar humerus (SCH) fracture is the most common paediatric elbow fracture. Treatment options range from nonoperative treatment (taping or casting) to operative treatments (closed reduction and percutaneous pinning or open reduction). Classification variability between surgeons is a potential contributing factor to existing controversy over treatment options for type II SCH fractures. This study investigated levels of agreement in extension-type SCH fracture classification using the modified Gartland classification system. Methods A retrospective review was conducted on 60 patients aged between two and 12 years who had sustained an extension-type SCH fracture and received operative or nonoperative treatment at a tertiary children’s hospital. Baseline radiographs were provided, and surgeons were asked to classify the fractures as type I, IIA, IIB or III according to the modified Gartland classification. Respondents were then asked to complete a second round of classifications using reshuffled radiographs. Weighted kappa values were calculated to assess interobserver and intraobserver levels of agreement. Results In all, 21 paediatric orthopaedic surgeons responded to the survey and 15 completed a second round of ratings. Interobserver agreement for classification based on the Gartland criteria between surgeons was substantial with a kappa of 0.679 (95% confidence interval (CI) 0.501 to 0.873). Intraobserver agreement was substantial with a kappa of 0.796, (95% CI 0.628 to 0.864) Conclusion Radiographic classification of extension-type SCH fractures demonstrated substantial agreement both between and within surgeon raters. Therefore, classification variability may not be a major contributing factor to the treatment controversy for type II SCH fractures and treatment variability may be due to differences in surgeon preferences. Level of Evidence III
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CRYER, HENRY M., FRANK B. MILLER, B. MARK EVERS, LAWRENCE R. ROUBEN, and DAVID L. SELIGSON. "Pelvic Fracture Classification." Journal of Trauma: Injury, Infection, and Critical Care 28, no. 7 (July 1988): 973–80. http://dx.doi.org/10.1097/00005373-198807000-00011.
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Burstein, A. H. "Fracture classification systems." Journal of Bone & Joint Surgery 75, no. 12 (December 1993): 1743–44. http://dx.doi.org/10.2106/00004623-199312000-00001.
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Neer, C. S. "Fracture classification systems." Journal of Bone & Joint Surgery 76, no. 5 (May 1994): 789–90. http://dx.doi.org/10.2106/00004623-199405000-00020.
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Rockwood, C. A. "Fracture classification systems." Journal of Bone & Joint Surgery 76, no. 5 (May 1994): 790. http://dx.doi.org/10.2106/00004623-199405000-00021.
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Bigliani, L. V., E. L. Flatow, and R. G. Pollock. "Fracture classification systems." Journal of Bone & Joint Surgery 76, no. 5 (May 1994): 790–92. http://dx.doi.org/10.2106/00004623-199405000-00022.
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Cuomo, F. "Fracture classification systems." Journal of Bone & Joint Surgery 76, no. 5 (May 1994): 792. http://dx.doi.org/10.2106/00004623-199405000-00023.
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Bernstein, J. "Fracture classification systems." Journal of Bone & Joint Surgery 76, no. 5 (May 1994): 792–93. http://dx.doi.org/10.2106/00004623-199405000-00024.
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Marsh, J. L. "OTA Fracture Classification." Journal of Orthopaedic Trauma 23, no. 8 (September 2009): 551. http://dx.doi.org/10.1097/bot.0b013e3181ad5e92.
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Belloti, João Carlos, Marcel Jun Sugawara Tamaoki, Carlos Eduardo da Silveira Franciozi, João Baptista Gomes dos Santos, Daniel Balbachevsky, Eduardo Chap Chap, Walter Manna Albertoni, and Flávio Faloppa. "Are distal radius fracture classifications reproducible? Intra and interobserver agreement." Sao Paulo Medical Journal 126, no. 3 (May 2008): 180–85. http://dx.doi.org/10.1590/s1516-31802008000300008.
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CONTEXT AND OBJECTIVE: Various classification systems have been proposed for fractures of the distal radius, but the reliability of these classifications is seldom addressed. For a fracture classification to be useful, it must provide prognostic significance, interobserver reliability and intraobserver reproducibility. The aim here was to evaluate the intraobserver and interobserver agreement of distal radius fracture classifications. DESIGN AND SETTING: This was a validation study on interobserver and intraobserver reliability. It was developed in the Department of Orthopedics and Traumatology, Universidade Federal de São Paulo - Escola Paulista de Medicina. METHOD: X-rays from 98 cases of displaced distal radius fracture were evaluated by five observers: one third-year orthopedic resident (R3), one sixth-year undergraduate medical student (UG6), one radiologist physician (XRP), one orthopedic trauma specialist (OT) and one orthopedic hand surgery specialist (OHS). The radiographs were classified on three different occasions (times T1, T2 and T3) using the Universal (Cooney), Arbeitsgemeinschaft für Osteosynthesefragen/Association for the Study of Internal Fixation (AO/ASIF), Frykman and Fernández classifications. The kappa coefficient (κ) was applied to assess the degree of agreement. RESULTS: Among the three occasions, the highest mean intraobserver k was observed in the Universal classification (0.61), followed by Fernández (0.59), Frykman (0.55) and AO/ASIF (0.49). The interobserver agreement was unsatisfactory in all classifications. The Fernández classification showed the best agreement (0.44) and the worst was the Frykman classification (0.26). CONCLUSION: The low agreement levels observed in this study suggest that there is still no classification method with high reproducibility.
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Audigé, Laurent, Carl-Peter Cornelius, Christoph Kunz, Carlos H. Buitrago-Téllez, and Joachim Prein. "The Comprehensive AOCMF Classification System: Classification and Documentation within AOCOIAC Software." Craniomaxillofacial Trauma & Reconstruction 7, no. 1_suppl (December 2014): 114–22. http://dx.doi.org/10.1055/s-0034-1389564.
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The AOCMF Classification Group developed a hierarchical three-level craniomaxillofacial (CMF) fracture classification system. The fundamental level 1 distinguishes four major anatomical units including the mandible (code 91), midface (code 92), skull base (code 93) and cranial vault (code 94); level 2 relates to the location of the fractures within defined topographical regions within each units; level 3 relates to fracture morphology in these regions regarding fragmentation, displacement, and bone defects, as well as the involvement of specific anatomical structures. The resulting CMF classification system has been implemented into AO comprehensive injury automatic classifier (AOCOIAC) software allowing for fracture classification as well as clinical documentation of individual cases including a selected sample of diagnostic images. This tutorial highlights the main features of the software. In addition, a series of illustrative case examples is made available electronically for viewing and editing.
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Boszczyk, Andrzej, and Stefan Rammelt. "Ankle fracture – correlation of Lauge-Hansen classification and patient reported fracture mechanism." Foot & Ankle Orthopaedics 3, no. 3 (July 1, 2018): 2473011418S0016. http://dx.doi.org/10.1177/2473011418s00165.
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Category: Trauma Introduction/Purpose: The genetic Lauge-Hansen classification is considered to provide a link between mechanism of ankle injury and resulting fracture morphology. In this study, we addressed the question of agreement between the mechanism of the fracture as postulated by the Lauge-Hansen classification and mechanism reported by the patient in rotational ankle fractures. Understanding of the actual mechanisms of ankle fracture may guide treatment decisions. Methods: Of 110 screened patients with acute malleolar fractures, 78 were able to provide information on their fracture mechanism and were included in the study. The study group consisted of 43 women and 35 men with a mean age of 47.8 (range 19.5-88.4) years. Patients were asked to describe the direction of deformation with primary question being pronation and supination as demonstrated by the examiner. As hyperplantarflexion and hyperdorsiflexion has been spontaneously reported by the patients, these directions were added to the analysis. Radiographs were analyzed according to Lauge-Hansen classification and compared with fracture mechanisms reported by the patients. Results: The majority (35/78 = 44.8%) of patients reported pronation as their fracture mechanism, 27 (34.6%) patients reported supination, 15 (19.2%) patients reported hyperplantarflexion (3 pure, one combined with pronation and 11 combined with supination), and 1 patient reported hyperdorsiflexion combined with pronation. Radiographs revealed 61 supination-external rotation (79%), 1 supination-adduction (1.3%), 14 pronation-external rotation (18%), 1 pronation-abduction (1.3%) fractures. One x-ray was unclassifiable with the Lauge-Hansen classification. The patient reported mechanisms were in concordance with the mechanism deducted from the x-rays in 49% of cases. Only 17% of patients who recalled a pronation trauma actually had radiographs classified as pronation fractures while 76% of patients who recalled a supination trauma were also radiographically classified as having sustained supination type fractures. Conclusion: The Lauge-Hansen classification should be used with caution for determining the actual mechanism of injury as it was able to predict the patient reported fracture mechanism in less than 50% of cases. A substantial percentage of fractures appearing radiographically as supination type injuries may have been actually produced by a pronation fracture mechanism.
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Quan, Yuan, Hao Lu, Hailin Xu, Yijun Liu, Wenyong Xie, Boyu Zhang, Dianying Zhang, and Baoguo Jiang. "The Distribution of Posterior Malleolus Fracture Lines." Foot & Ankle International 42, no. 7 (March 20, 2021): 959–66. http://dx.doi.org/10.1177/1071100721996700.
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Background: The morphology and classification of posterior malleolus (PM) fractures remain controversial. An increasing number of studies have found that merely focusing on the fragment size does not lead to a satisfactory prognosis. This study aimed to demonstrate the fracture line and comminution zones of PM fractures using computed tomography (CT), in order to provide insights into the injury mechanism of PM fractures. Methods: We retrospectively reviewed the data of 95 patients with PM fractures between 2013 and 2018 at a level 1 trauma center. The CT data of the PM of the patients were reconstructed using software. Images of all patients were superimposed together, and drawn as a heat map of the fragments and line distributions of PM fractures. Results: Our study included 66 type I, 19 type II, and 10 type III PM fractures according to the classification of Haraguchi. In the single-fragment fracture group, the fracture lines were mainly concentrated in the posterolateral tibial tubercle area (Volkmann’s tubercle) and a larger tubercle area involving the tibialis posterior groove. In the multifragment fracture group, there were 10 (43.5%) patients with a 2-fragment pattern and 13 (56.5%) patients with a compressive-fragment pattern. Conclusion: According to the fracture map and previous studies on the syndesmosis, our study provides a different understanding of the pathomechanisms of ankle injuries compared with previous classifications of PM fractures. Level of Evidence: Level III, retrospective study.
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Toro, Giuseppe, Antimo Moretti, Daniele Ambrosio, Raffaele Pezzella, Annalisa De Cicco, Giovanni Landi, Nicola Tammaro, et al. "Fractures around Trochanteric Nails: The “Vergilius Classification System”." Advances in Orthopedics 2021 (January 12, 2021): 1–9. http://dx.doi.org/10.1155/2021/7532583.
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Introduction. The fractures that occurred around trochanteric nails (perinail fractures, PNFs) are becoming a huge challenge for the orthopaedic surgeon. Although presenting some specific critical issues (i.e., patients’ outcomes and treatment strategies), these fractures are commonly described within peri-implant ones and their treatment was based on periprosthetic fracture recommendations. The knowledge gap about PNFs leads us to convene a research group with the aim to propose a specific classification system to guide the orthopaedic surgeon in the management of these fractures. Materials and Methods. A steering committee, identified by two Italian associations of orthopaedic surgeons, conducted a comprehensive literature review on PNFs to identify the unmet needs about this topic. Subsequently, a panel of experts was involved in a consensus meeting proposing a specific classification system and formulated treatment statements for PNFs. Results and Discussion. The research group considered four PNF main characteristics for the classification proposal: (1) fracture localization, (2) fracture morphology, (3) fracture fragmentation, and (3) healing status of the previous fracture. An alphanumeric code was included to identify each characteristic, allowing to describe up to 54 categories of PNFs, using a 3- to 4-digit code. The proposal of the consensus-based classification reporting the most relevant aspects for PNF treatment might be a useful tool to guide the orthopaedic surgeon in the appropriate management of these fractures.
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Yearson, Diego, Ignacio Melendez, Federico Anain, Santiago Siniscalchi, and Juan Drago. "Posterior malleolar fractures. New classification and treatment algorithm." Journal of the Foot & Ankle 14, no. 3 (December 21, 2020): 254–59. http://dx.doi.org/10.30795/jfootankle.2020.v14.1199.
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Objective: This study proposes a new classification of posterolateral malleolar fractures and a treatment algorithm. Methods: We divided the posterolateral malleolus, which we considered as the posterior malleolus, from the posteromedial one, which we considered as being part of the medial malleolus fracture. The experience with 77 patients treated from February 2017 to February 2020 was assessed. All of them were assessed by frontal and profile radiographies and computed tomography (CT). Among the parameters to classify these fractures, we believe the most determining ones are fracture size, followed by presence of fracture displacement. Results: Fractures were divided into those whose posterior fragment was 25% smaller than the tibial joint surface and those that compromised more than 25% of this joint. The first group underwent syndesmotic opening and was subclassified into 1A (stable fractures), which do not require surgical treatment, and 1B (unstable), which require syndesmotic stabilization. The second group, which comprised the larger fractures, was subclassified into 2 A (non-displaced fractures, or with a displacement below 2 mm), which underwent percutaneous osteosynthesis, 2B (displaced fractures), and 2C (comminuted fractures), which underwent open reduction and internal fixation using a posterior approach. Conclusion: The classifications published so far are anatomic or descriptive, but none of them proposes a therapeutic algorithm for each type of fracture. We believe it will be helpful for its interpretation and decision-making on the need to perform a posterior approach, prioritizing the anatomical reduction of the joint fragment and resolution of syndesmotic instability linked to each fracture pattern using the most simple and effective method. Level of Evidence IV; Therapeutic Studies; Case Series.
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Dharmshaktu, Ganesh Singh. "An unreported variant of fracture neck femur: a case report." International Journal of Scientific Reports 1, no. 1 (May 2, 2015): 102. http://dx.doi.org/10.18203/issn.2454-2156.intjscirep20150215.
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<p class="abstract">Fracture neck femur is common but ‘unsolved’ injury. Despite many classifications certain fractures do not fit into well recognized patterns or classifications. We report an unreported variation of the intraoperatively detected fracture. The fracture consisted of a subcapital fracture with a long intramedullary spike along the neck of femur attached to proximal segment. The patient was managed accordingly with good functional outcome. </p><p class="keywords"><strong><span lang="EN-US">Keywords: </span></strong>Fracture neck femur, Classification, Management, Hip trauma<strong></strong></p>
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Sarma, Nayanjyoti, and Abhinandan Bhattacharjee. "Understanding Nasal Bone Fractures and Its Effects on Management: A Prospective Study." An International Journal Clinical Rhinology 7, no. 2 (2014): 58–60. http://dx.doi.org/10.5005/jp-journals-10013-1195.
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ABSTRACT Objective To evaluate mode of injury and different management options reliant on types of nasal bone fractures. Study design Prospective analytical study. Subjects and methods Seventy-five patients with nasal bone fractured were clinically and radiologically evaluated and divided into different types according to Lee's classification. They were provided conservative, closed reduction and/or osteotomy according to the type of fracture and outcome noted. Results Lee's classification is found to be valid in real patient scenarios and using good radiological evaluation better post operative outcome can be achieved. For type 1 and 3 fractures, closed reduction and osteotomy are the treatment of choice. Conclusion We confirm that systematic approach on Lee's classification for nasal bone fracture can be used to select appropriate management strategy. How to cite this article Sarma N, Bhattacharjee A. Understanding Nasal Bone Fractures and Its Effects on Management: A Prospective Study. Clin Rhinol An Int J 2014;7(2):58-60.
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Bernstein, J., B. A. Monaghan, J. S. Silber, and W. G. DeLong. "Taxonomy and treatment – a classification of fracture classifications." Journal of Bone and Joint Surgery. British volume 79-B, no. 5 (September 1997): 706–7. http://dx.doi.org/10.1302/0301-620x.79b5.0790706.
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Trompeter, Alex J., Ruth Knight, Nick Parsons, and Matthew L. Costa. "The Orthopaedic Trauma Society classification of open fractures." Bone & Joint Journal 102-B, no. 11 (November 1, 2020): 1469–74. http://dx.doi.org/10.1302/0301-620x.102b11.bjj-2020-0825.r1.
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Aims To describe a new objective classification for open fractures of the lower limb and to correlate the classification with patient-centred outcomes. Methods The proposed classification was investigated within a cohort of adults with open fractures of the lower limb who were recruited as part of two large clinical trials within the UK Major Trauma Network. The classification was correlated with patient-reported Disability Rating Index (DRI) and EuroQol five-dimension questionnaire (EQ-5D) health-related quality of life in the year after injury, and with deep infection at 30 days, according to the Centers for Disease Control and Prevention definition of a deep surgical site infection. Results A total of 748 participants were included in the analysis. Of these, 288 (38.5%) had a simple open fracture and 460 (61.5%) had a complex fracture as defined by the new classification system. At 12 months, the mean DRI in the simple fracture group was 32.5 (SD 26.8) versus 43.9 (SD 26.1) in the complex fracture group (adjusted mean difference 8.19; 95% confidence interval (CI) 3.69 to 12.69). At 12 months the mean health-related quality of life (EQ-5D utility) in the simple fracture group was 0.59 (SD 0.29) versus 0.56 (SD 0.32) in the complex fracture group (adjusted mean difference -0.03; 95% CI -0.09 to 0.02). The differences in the rate of deep infection at 30 days was not statistically significant. Conclusion The Orthopaedic Trauma Society open fracture classification is based upon objective descriptors of the injury and correlates with patient-centred outcomes in a large cohort of open fractures of the lower limb. Cite this article: Bone Joint J 2020;102-B(11):1469–1474.
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Kerschbaum, Maximilian, Morgane Tyczka, Lisa Klute, Marie Theres Heller, Matthias Koch, Daniel Popp, Siegmund Lang, Volker Alt, and Michael Worlicek. "The Tibial Plateau Map: Fracture Line Morphology of Intra-Articular Proximal Tibial Fractures." BioMed Research International 2021 (August 24, 2021): 1–6. http://dx.doi.org/10.1155/2021/9920189.
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The purpose of this study was to characterize the patterns of a large series of tibial plateau fractures with the use of fracture mapping, with regard to different fracture types using the OTA/AO and Schatzker classification. Patients with intra-articular fractures of the tibial plateau were evaluated, using the OTA/AO and Schatzker classification on CT scans. For fracture mapping, the axial slice that completely displayed the tibial joint plane was first identified, then matched to a template congruently, and the fracture lines were identified and reproduced. In addition to epidemiological data (age and gender), the trauma mechanism (high-energy, low-energy, and pathological fracture) was recorded. In total, 271 patients with 278 intra-articular fractures of the tibial head were analyzed, including seven patients with both sides affected. The mean age was 49.1 years (men 46.3 years, women 53.5 years). The majority of fractures was caused by high-energy trauma. No significant difference could be shown with respect to trauma mechanism and resulting fracture type in terms of OTA/AO ( p = 0.352 ) or Schatzker classification ( p = 0.884 ). A significant difference could be found with respect to gender and resulting fracture type in terms of OTA/AO ( p = 0.031 ). 170 (61.2%) were OTA/AO type B fractures, and 108 (38.8%) were type C fractures. Using the Schatzker classification, we found 53 type I (19.1%), 60 type II (21.6%), 27 type III (9.7%), 32 type IV (11.5%), 16 type V (5.8%), and 90 type VI (32.4%) fractures. The main affection was found in the lateral and intermedial column of the tibial plateaus, concerning both OTA/AO and Schatzker classification. The variability of intra-articular tibial head fractures is very high. In consequence, an individual analysis of fracture patterns and therapy planning by using CT scans is crucial.
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DESAI, V. V., T. R. C. DAVIS, and N. J. BARTON. "The Prognostic Value and Reproducibility of the Radiological Features of the Fractured Scaphoid." Journal of Hand Surgery 24, no. 5 (October 1999): 586–90. http://dx.doi.org/10.1054/jhsb.1999.0197.
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We investigated whether the radiological features of the fractured scaphoid could be reproducibly measured and used to predict the likelihood of union with conservative plaster cast immobilization. We found that the inter- and intra-observer reproducibility of the Compson, Herbert and Russe classification systems were only fair and that none predicted fracture union. Assessments of fracture level, comminution and displacement showed moderate inter- and intra-observer reproducibility but did not predict the likelihood of fracture union. We conclude that the radiological features of acute scaphoid fractures cannot be used to predict the likelihood of fracture union.
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Adams, Mark R., Kenneth L. Koury, Jaydev B. Mistry, William Braaksma, John S. Hwang, and Reza Firoozabadi. "Plantar Medial Avulsion Fragment Associated With Tongue-Type Calcaneus Fractures." Foot & Ankle International 40, no. 6 (March 6, 2019): 634–40. http://dx.doi.org/10.1177/1071100719830948.
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Background: The plantar fascia attaches to the tuberosity of the calcaneus, which produces a distinct plantar medial avulsion (PMA) fracture fragment in certain calcaneal fractures. We hypothesized that tongue-type fractures, as described by the Essex-Lopresti classification, were more likely to be associated with this PMA fracture than joint depression fractures. Methods: A retrospective chart review was performed at 2 distinct Level I trauma centers to identify patients sustaining calcaneal fractures. Radiographs were then reviewed to determine the Essex-Lopresti classification, OTA classification, and presence of a PMA fracture. Results: The review yielded 271 total patients with 121 (44.6%) tongue-type (TT), 110 (40.6%) joint depression (JD), and 40 (14.8%) fractures not classifiable by the Essex-Lopresti classification. In the TT group, 73.6% of the patients had the PMA fracture whereas only 8.2% of JD and 15.0% of nonclassifiable fractures demonstrated a PMA fragment ( P < .001). Conclusion: Plantar medial avulsion fractures occurred in 38.4% of the calcaneal fractures reviewed with a significantly greater proportion occurring in TT (73.6%) as opposed to JD (8.2%). Given the plantar fascia attachment to the PMA fragment, there may be clinical significance to identifying this fracture and changing treatment management; however, this requires further investigation. Level of Evidence: Level III, comparative study.
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Lind, Anna, Ehsan Akbarian, Simon Olsson, Hans Nåsell, Olof Sköldenberg, Ali Sharif Razavian, and Max Gordon. "Artificial intelligence for the classification of fractures around the knee in adults according to the 2018 AO/OTA classification system." PLOS ONE 16, no. 4 (April 1, 2021): e0248809. http://dx.doi.org/10.1371/journal.pone.0248809.
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Background Fractures around the knee joint are inherently complex in terms of treatment; complication rates are high, and they are difficult to diagnose on a plain radiograph. An automated way of classifying radiographic images could improve diagnostic accuracy and would enable production of uniformly classified records of fractures to be used in researching treatment strategies for different fracture types. Recently deep learning, a form of artificial intelligence (AI), has shown promising results for interpreting radiographs. In this study, we aim to evaluate how well an AI can classify knee fractures according to the detailed 2018 AO-OTA fracture classification system. Methods We selected 6003 radiograph exams taken at Danderyd University Hospital between the years 2002–2016, and manually categorized them according to the AO/OTA classification system and by custom classifiers. We then trained a ResNet-based neural network on this data. We evaluated the performance against a test set of 600 exams. Two senior orthopedic surgeons had reviewed these exams independently where we settled exams with disagreement through a consensus session. Results We captured a total of 49 nested fracture classes. Weighted mean AUC was 0.87 for proximal tibia fractures, 0.89 for patella fractures and 0.89 for distal femur fractures. Almost ¾ of AUC estimates were above 0.8, out of which more than half reached an AUC of 0.9 or above indicating excellent performance. Conclusion Our study shows that neural networks can be used not only for fracture identification but also for more detailed classification of fractures around the knee joint.
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Freibott, Christina, Seth C. Shoap, Sebastian F. Baumbach, Kathrin Rellensmann, Rami Alrabaa, Hans Polzer, Justin K. Greisberg, and J. Turner Vosseller. "Syndesmosis Injuries in Ankle Fractures: Correlation of Fracture Type and Syndesmotic Instability." Foot & Ankle Orthopaedics 5, no. 4 (October 1, 2020): 2473011420S0021. http://dx.doi.org/10.1177/2473011420s00219.
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Category: Ankle; Trauma Introduction/Purpose: Ankle fractures are among the most common injuries treated by orthopedic surgeons. Syndesmotic disruption in ankle fractures can be identified preoperatively, however the decision to fix the syndesmosis is made after this intraoperative assessment. The AO classification groups ankle or malleolar fractures into A (infrasyndesmotic fibula fracture), B (transsyndesmotic fibula fracture), and C (suprasyndesmotic fibula fracture) with succeeding digits that further classify each fracture group in more detail. This study aimed to retrospectively review databases of ankle fractures across two major academic centers to determine the rate of syndesmotic injury and to assess the association between ankle fracture type (utilizing the AO classification) and presence of syndesmotic injury. Methods: Patients 18 years or older who were treated surgically for an ankle fracture at two major academic institutions between 2010 and 2016 were selected for review. Exclusion criteria were open fractures, pilon fractures, tibial shaft fractures, or patients who underwent open reduction and internal fixation of an ankle fracture involving the posterior malleolus. The preoperative injury films of each ankle fracture was reviewed and classified according to the AO classification. The postoperative films were then reviewed for each case to classify the fractures into stable or unstable syndesmosis based on whether syndesmotic fixation was performed. Stability of the syndesmosis was tested intraoperatively after internal fixation of the fracture fragments using the Cotton test and external rotation stress views. Fixation of the syndesmosis was performed with either a syndesmotic screw or suture button fixation per surgeon preference. Chi-square analysis was used to assess the association between fracture types and syndesmotic injury. Results: 733 patients met inclusion criteria. Average patient age was 54.22 with 52.8% being female. 273 patients had sustained a syndesmotic injury (Figure 1). Association between fracture type (AO classification) and syndesmotic injury was assessed with chi- square analysis showing significant association (X28=193.842, p<0.001). Type B fractures in this study were further classified with AO classification (9 subcategories) to assess for an association with syndesmotic injury within a subcategory of these fractures (Figure 1). Chi-square analysis of type B fracture subgroups revealed significant association between fracture subgroup and syndesmotic disruption (X28=76.379, p<0.001). There was a statistically significant association between single digit AO classification and syndesmotic injury (X28=193.842, p<0.001) as well as the two-digit AO classification for type B fractures and syndesmotic injury (X28=76.379, p<0.001). Conclusion: This study aimed to identify ankle fracture patterns that are prone to syndesmotic injury. Identifying fractures preoperatively that are likely to have syndesmotic injury is beneficial to surgeon and patient as it aids in operative planning, intraoperative equipment needs, managing patient expectations, and counselling patients preoperatively about changes in rehabilitation protocols with injuries that involve the syndesmosis. Most of the type C fractures (88.50%) had syndesmotic injury, 7.14% of type A fractures involved the syndesmosis, and type B fractures had variable syndesmotic involvement (31.15%). Chi- square analysis revealed that significant association exists between type B2 and syndesmotic injury (X28=76.379, p<0.001).
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Ellis, Henry B., Aaron J. Zynda, Aristides I. Cruz, Brant Sachleben, Catherine Sargent, Daniel W. Green, Drew E. Warnick, et al. "RELIABILITY IN RADIOGRAPHIC REVIEW OF TIBIAL SPINE FRACTURES IN A TIBIAL SPINE RESEARCH INTEREST GROUP." Orthopaedic Journal of Sports Medicine 7, no. 3_suppl (March 1, 2019): 2325967119S0006. http://dx.doi.org/10.1177/2325967119s00069.
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BACKGROUND: Variability that exists amongst the radiographic measurement parameters associated with tibial spine fractures may have direct consequences when comparing, reporting, or treating these injuries. In developing data collection of tibial spine fractures amongst multiple centers, it is important to establish reliability in radiographic parameters. Therefore, we designed a study to validate the classification and a proposed cohort of measurements of tibial spine fractures amongst multiple institutions to assist with standardizing fracture classification and treatment decisions. METHODS: Radiographic assessment of de-identified acute tibial spine fractures was performed by members of the Pediatric Research in Sports Medicine (PRISM) Tibial Spine Research Interest Group. A descriptive Powerpoint presentation was provided to each reviewer demonstrating specific measurements and classification prior to review. Reviewers were also asked to provide treatment recommendations. DICOM files were provided to the surgeon through a web-based shared drive and reviewers were required to use the same imaging software. There were 40 patients included, determined through power analysis performed based on previous reliability studies and the number of participants. Assuming the intraclass correlation coefficient (ICC) will be .85 and 95% confidence interval to be 0.2, the sample size of 40 will achieve the desired 95% confidence. Data will be reviewed using both kappa and ICC reliability measures due to both categorical and continuous data points. RESULTS: A majority of radiographic measures demonstrated moderate ICC including posterior-proximal displacement (0.378), length and height of tibial spine fracture (0.466 and 0.535, respectively), and superior displacement of medial fragment (0.420). Good ICC was seen with superior displacement of the anterior tibial spine fragment (0.734). Poor correlation was seen with the measurements for anterior displacement, posterior sagittal displacement, and roof inclination angle. Classifying tibial spine fractures according to the historical Meyer & McKeever Classification demonstrated fair agreement (kappa = 0.347). 18 of 40 (45%) fracture patterns were classified by reviewers in three or more different classifications types while only 1 fracture pattern (Type 1) was agreed upon by all reviewers. A majority of reviewers recommended arthroscopic treatment with suture for more fracture patterns. However, there was fair agreement with the initial treatment regarding operative versus closed reduction (kappa = 0.328). CONCLUSION: Measurement of superior displacement of anterior tibial spine fracture on the lateral images is the only radiographic assessment with good correlation or agreement amongst a group of surgeons in a Tibial Spine Research Group. Classification of tibial spine fractures did not demonstrate acceptable agreement. Further studies and classification methodology is needed to standardize fracture patterns and thereby study outcomes based on pattern and treatment.
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Mansur, Henrique, Lucas Sacramento Ramos, and Anderson Freitas. "TL 18167 - Reproducibility assessment of the Lauge-Hansen, Danis-Weber and AO classifications of ankle fractures." Scientific Journal of the Foot & Ankle 13, Supl 1 (November 11, 2019): 98S. http://dx.doi.org/10.30795/scijfootankle.2019.v13.1093.
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Introduction: Although there are some studies on the reproducibility of various classifications of ankle fractures, they are controversial and lack consensus on which classification is the most appropriate. Thus, the objective of this study is to identify which of the 3 main ankle fracture classifications has the highest intra- and interobserver reproducibility and to assess whether the medical training stage of the participants affects the evaluation. Methods: Radiographs of 30 patients with ankle fracture in anteroposterior (AP), profile and true AP views were selected. All images were evaluated by 11 participants at different stages of their medical training (5 residents and 6 orthopedic surgeons) and at 2 different times. Intra- and interobserver agreement was analyzed using the weighted Cohen's kappa coefficient. Paired Student's t-tests were performed to assess whether the degree of interobserver agreement significantly differed between classification methods. Results: The results showed significant agreement in all classifications when analyzing intraobserver agreement alone. The Danis-Weber classification showed a highly significant (p<0.0001) moderate-to-excellent interobserver agreement. The Danis-Weber classification had, on average, a significantly higher degree of agreement than the other classification methods (p<0.0001). Conclusion: The Danis-Weber classification had the highest reproducibility among the classification methods evaluated in this study.
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Daniels, Anne M., Caroline E. Wyers, Heinrich M. J. Janzing, Sander Sassen, Daan Loeffen, Sjoerd Kaarsemaker, Bert van Rietbergen, Pascal F. W. Hannemann, Martijn Poeze, and Joop P. van den Bergh. "The interobserver reliability of the diagnosis and classification of scaphoid fractures using high-resolution peripheral quantitative CT." Bone & Joint Journal 102-B, no. 4 (April 2020): 478–84. http://dx.doi.org/10.1302/0301-620x.102b4.bjj-2019-0632.r3.
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Aims Besides conventional radiographs, the use of MRI, CT, and bone scintigraphy is frequent in the diagnosis of a fracture of the scaphoid. However, which techniques give the best results remain unknown. The investigation of a new imaging technique initially requires an analysis of its precision. The primary aim of this study was to investigate the interobserver agreement of high-resolution peripheral quantitative CT (HR-pQCT) in the diagnosis of a scaphoid fracture. A secondary aim was to investigate the interobserver agreement for the presence of other fractures and for the classification of scaphoid fracture. Methods Two radiologists and two orthopaedic trauma surgeons evaluated HR-pQCT scans of 31 patients with a clinically-suspected scaphoid fracture. The observers were asked to determine the presence of a scaphoid or other fracture and to classify the scaphoid fracture based on the Herbert classification system. Fleiss kappa statistics were used to calculate the interobserver agreement for the diagnosis of a fracture. Intraclass correlation coefficients (ICCs) were used to assess the agreement for the classification of scaphoid fracture. Results A total of nine (29%) scaphoid fractures and 12 (39%) other fractures were diagnosed in 20 patients (65%) using HR-pQCT across the four observers. The interobserver agreement was 91% for the identification of a scaphoid fracture (95% confidence interval (CI) 0.76 to 1.00) and 80% for other fractures (95% CI 0.72 to 0.87). The mean ICC for the classification of a scaphoid fracture in the seven patients diagnosed with scaphoid fracture by all four observers was 73% (95% CI 0.42 to 0.94). Conclusion We conclude that the diagnosis of scaphoid and other fractures is reliable when using HR-pQCT in patients with a clinically-suspected fracture. Cite this article: Bone Joint J 2020;102-B(4):478–484.
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Alawad, Mohammad O., Saleh Alharthi, Jameel Mahmoud, Basam Alanazi, and Saad Surur. "Open Fracture of the Acromion: An Isolated Injury with Oblique-Type Fracture." Case Reports in Orthopedics 2018 (June 10, 2018): 1–3. http://dx.doi.org/10.1155/2018/2107059.
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Open acromial fractures are a rare set of fractures. We report a case of Gustilo IIIA open acromial fracture (14A2 as per OTA scapular fracture classification) that was isolated from any other injury. Our patient had a good recovery and showed excellent clinical outcome after irrigation and screw fixation of the acromial fracture. We also reviewed the literature for other cases of open acromial fracture.
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Nogueira, Alysson Figueiredo, Lucas Moratelli, Marcela dos Santos Martins, Ricardo Torres Iupi, Marcos Felipe Marcatto de Abreu, and João Carlos Nakamoto. "EVALUATION OF DISTAL FOREARM FRACTURES USING THE AO 2018 CLASSIFICATION." Acta Ortopédica Brasileira 27, no. 4 (August 2019): 220–22. http://dx.doi.org/10.1590/1413-785220192704218467.
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ABSTRACT Objective: Distal forearm fractures are among the most common upper limb fractures in all ages, and many classifications have been proposed to describe them. Recently, a new version of AO/OTA classification was proposed. The aim of this study is to use the AO/OTA 2018 classification to report the epidemiology of distal forearm fractures in adults treated at a single center. Methods: A retrospective analysis of the initial radiographs obtained from cases of distal forearm fractures in an orthopedic emergency room at a single tertiary hospital. Results: Three hundred twenty-two cases were studied, aged 50.35 ± 18.98 years, 55.3% were female and 44.7% were right-sided. Type 2R3A, 2R3B and 2R3C fractures corresponded to 32.3%, 18.0% and 48.4% of the cases, respectively. Distal ulnar fracture was present in 41.9%. There was a correlation between age and sex: 78.3% of the subjects aged under 30 years were male, and 80.6% of those aged over 60 years were female (p<0.001). Conclusion: The most common type of radial fractures was 2R3C, and the most common type of ulna fracture was 2U3A1.1. There was a correlation between age and sex. Level of evidence IV, Case-series.
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Şentürk, Salim, Ahmet Öğrenci, Ahmet Gürhan Gürçay, Ahmet Atilla Abdioğlu, Onur Yaman, and Ali Fahir Özer. "Classification of Radiological Changes in Burst Fractures." Open Access Macedonian Journal of Medical Sciences 6, no. 2 (February 14, 2018): 359–63. http://dx.doi.org/10.3889/oamjms.2018.094.
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AIM: Burst fractures can occur with different radiological images after high energy. We aimed to simplify radiological staging of burst fractures.METHODS: Eighty patients whom exposed spinal trauma and had burst fracture were evaluated concerning age, sex, fracture segment, neurological deficit, secondary organ injury and radiological changes that occurred.RESULTS: We performed a new classification in burst fractures at radiological images.CONCLUSIONS: According to this classification system, secondary organ injury and neurological deficit can be an indicator of energy exposure. If energy is high, the clinical status will be worse. Thus, we can get an idea about the likelihood of neurological deficit and secondary organ injuries. This classification has simplified the radiological staging of burst fractures and is a classification that gives a very accurate idea about the neurological condition.
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Macdermid, Joy C., Robert S. Richards, Allan Donner, Nick Bellamy, James H. Roth, and Kevin A. Hildebrand. "Reliability of Hand Fellows’ Measurements and Classifications from Radiographs of Distal Radius Fractures." Canadian Journal of Plastic Surgery 9, no. 2 (April 2001): 51–58. http://dx.doi.org/10.1177/229255030100900204.
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The inter-rater reliability of classification systems and the direct measurement of fracture displacement was evaluated for two hand fellows in 128 radiographs of distal radius fractures. The fracture classifications rated were the Older, Mayo, AO, McMurtry, Universal and Frykman systems. Measurements of displacement were radial tilt, radial shortening and dorsal angulation on pre- and postreduction films. Intraclass correlation coefficients (ICCs) and kappas, and their associated 95% confidence intervals were calculated. Inter-rater reliability for classification systems was poor, with the exception of the Older system (kappa = 0.73). Prereduction measurement of radial inclination, dorsal angulation and radial shortening had excellent reliability (ICC 0.77). Postreduction films exhibited lower reliability in the same measurements (ICC 0.76). Hand fellows reported inconsistent use of classification systems or radiographical measurements in clinical practice. Further training and/or an increased emphasis on direct measurements, rather than classifications, may be warranted.
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Tamaru, Takuya, Kunio Sasaki, Atsushi Shimizu, Kouichi Watanabe, Akihiro Nishii, Tsuneaki Matsuura, and Keizou Akagi. "New Trochanteric Fracture Classification." Orthopedics & Traumatology 41, no. 1 (1992): 216–18. http://dx.doi.org/10.5035/nishiseisai.41.216.
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Metha, A. C., and J. M. Thome. "The Fracture Classification Manual." Cleveland Clinic Journal of Medicine 59, no. 4 (July 1, 1992): 428. http://dx.doi.org/10.3949/ccjm.59.4.428-b.
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Sanders, Roy. "The Fracture Classification Manual." Journal of Orthopaedic Trauma 6, no. 2 (June 1992): 266. http://dx.doi.org/10.1097/00005131-199206000-00025.
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Newman, Raymond J. "The fracture classification manual." Current Orthopaedics 5, no. 4 (October 1991): 288. http://dx.doi.org/10.1016/0268-0890(91)90027-w.
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Jiang, Lu, and Yang Song Zhang. "The Research on Mean Spacing of Rock Fracture." Applied Mechanics and Materials 580-583 (July 2014): 219–23. http://dx.doi.org/10.4028/www.scientific.net/amm.580-583.219.
Full textAbstract:
The mean spacing of rock fracture is a very important parameter base to evaluate rock mass,a number of rock studies base on it. Object of this paper is Beishan preselected area in Gansu Province, China. A uthor use GPS-RTK to measure the fracture’s endpoints and inflection, then process the resulting coordinate, building a three-dimensional model of rock fracture by using three-dimensional software and meshing the three-dimensional model, Through the analysis of fractures in each grid to calculate the linear density of rock fracture, after the orientation and inclination correction on linear density, it can be converted to an mean spacing of rock fractures. The mean spacing of rock fracture can be directly used for rock mass classification in GSI rock systems, and has a great significance in rock engineering studies.