Classification and Scoring of Fractures

Question 1

Danis-Weber Classification (ankle fracture)

Answer 1

• Type A
  
  • Fracture of the lateral malleolus distal to the syndesmosis. It is below the level of the ankle joint and the tibiofibular syndesmosis intact.
  • Deltoid ligament is intact and medial malleolus often fractured.
• Type B
  
  • The fracture of the fibula at the level of the syndesmosis and ankle joint, extending superiorly and laterally up the fibula.
  • The syndesmosis may be intact or only partially torn, but there is no widening of the distal tibiofibular articulation. The medial malleolus may be fractured or there may be a tear in the deltoid ligament.
• Type C
  
  • Fracture of the fibula is proximal to the syndesmosis/ankle joint and there is disruption of the syndesmosis. The distal tibiofibular joint is widened. The medial malleolus is fractured or there is a tear in the deltoid ligament.

Question 2

Salter-Harris Classification (physeal fractures - SALTR)

Answer 2

• Type 1 - Slipped
  
  • Fracture passes all the way through the growth plate, not involving bone
• Type 2 - Above
  
  • Fracture pases across most of the growth plate and up through the metaphysis
• Type 3 - Lower
  
  • Fracture plane passes some distance along with the growth plate and down through the epiphysis
• Type 4 - Through or transverse or together
  
  • Fracture plane passes directly through the metaphysis, growth plate and down through the epiphysis
• Type 5 - Ruined or rammed
  
  • Crushing type injury does not displace growth plate but damages it by direct compression
• Type 6
  
  • Injury to the perichondral structures
• Type 7
  
  • Isolated injury to the epiphyseal plate
• Type 8
  
  • Isolated injury to the mataphysis, with a potential injury to endochondral ossification
• Type 9
  
  • Injury to the periosteum that may interefere with membranous growth

Question 3

Ottowa Ankle Rules

Answer 3

• Ankle X-ray series required if:
  
  • Bone tenderness at posterior edge or tip of the lateral malleolus (A)
  • Bone tenderness at posterior edge or tip- of the medial malleolus (B)
  • An inability to weight bear both immediately and in the ED for four steps
• Foot X-ray required if:
  
  • Bone tenderness at the base of the fifth metatarsal (C)
  • Bone tenderness at the navicular (D)
  • An inability to weight bear both immediately and in the ED for four steps