Müller AO Classification of fractures

{{Short description|System for classifying bone fractures}}

File:AO Fracture Classification - Adult.png

The Müller AO Classification of fractures is a system for classifying bone fractures initially published in 1987{{cite book | title=Classification AO des fractures. Tome I. Les os longs | publisher=Springer-Verlag |vauthors=Müller ME, Nazarian S, Koch P | year=1987 | location=Berlin}} by the AO Foundation as a method of categorizing injuries according to therognosis of the patient's anatomical and functional outcome. "AO" is an initialism for the German "Arbeitsgemeinschaft für Osteosynthesefragen", the predecessor of the AO Foundation.

It is one of the few complete fracture classification systems to remain in use today after validation.{{cite journal | title=How reliable are reliability studies of fracture classifications? A systematic review of their methodologies |vauthors=Audigé L, Bhandari M, Kellam J | journal=Acta Orthop Scand | year=2004 | volume=75 | issue=2 | pages=184–94 | pmid=15180234 | doi=10.1080/00016470412331294445| doi-access= }}

Comprehensive classification of the long bones

The English language version of the system{{cite book | title=The Comprehensive Classification of Fractures of Long Bones | publisher=Springer-Verlag |vauthors=Müller ME, Nazarian S, Koch P, etal | year=1990 | location=New York}} allows consistent in detail description of a fracture in defined terminology by creating a 5-element alphanumeric code:

class="wikitable"
colspan="2"|Localisation

!colspan="3"|Morphology

Bone

|Segment

|Type

|Group

|Subgroup

1/2/3/4

|1/2/3/(4)

|A/B/C

|1/2/3

|.1/.2/.3

=Localisation=

First, each fracture is given 2 numbers to describe which bone it affects, and where in the bone:

class="wikitable"
!1

!2

!3

!4

Bone

|Humerus

|Radius and Ulna

|Femur

|Tibia and fibula

Segment

|Proximal segment

|Diaphyseal segment

|Distal segment

|Malleolar segment (only used with tibia and fibula

=Type=

Each fracture is next given a letter (A, B or C) to describe the joint involvement of the fracture:

class="wikitable"
Segment

!A

!B

!C

1

|Extra-articular

|Partial articular

|Complete articular

2

|Simple

|Wedge

|Complex

3

|Extra-articular

|Partial articular

|Complete articular

The exceptions to this step include:

class="wikitable"
Localisation

!A

!B

!C

11 - Proximal humerus

|Extra-articular, unifocal

|Extra-articular, bifocal

|Articular

31 - Proximal femur

|Extra-articular, trochanteric

|Extra-articular, neck

|Articular, head

44 - Malleoli

|Infrasydesmotic

|Transyndesmotic

|Suprasyndesmotic

=Groups & Subgroups=

Finally, the fracture is given 2 further numbers to denote the fracture pattern and geometry.

For segment 2 (diaphyseal) fractures:

class="wikitable"
rowspan="2"|Type

!colspan="3"|Group

1

!2

!3

A - simple

|Spiral

|Oblique

|Transverse

B - wedge

|Spiral

|Bending

|Multifragmentory

C - complex

|Spiral

|Segmental

|Irregular

For segment 1 and 3 (epiphyseal and metaphyseal) fractures:

class="wikitable"
rowspan="2"|Type

!colspan="3"|Group

1

!2

!3

A - extra-articular

|Simple

|Wedge

|Complex

B - partial articular

|Split

|Depression

|Split-depression

C - articular

|Simple articular, simple metaphyseal

|Simple articular, complex metaphyseal

|Complex articular, complex metaphyseal

Subgroups are then used to describe the fractures in terms of displacement (versus apposition, which is the degree to which the parts are in contact with each other), rotation, angulation and shortening.

AO pediatric comprehensive classification of long bone fractures

A pediatric version of the long-bone classification was published in 2006{{cite journal | title=Development and validation of the AO pediatric comprehensive classification of long bone fractures by the Pediatric Expert Group of the AO Foundation in collaboration with AO Clinical Investigation and Documentation and the International Association for Pediatric Traumatology | vauthors=Slongo T, Audigé L, Schlickewei W, Clavert JM, Hunter J, ((International Association for Pediatric Traumatology)) | journal=J Pediatr Orthop | year=2006 | volume=26 | issue=1 | pages=43–9 | pmid=16439900 | doi=10.1097/01.bpo.0000187989.64021.ml| s2cid=21127278 }} to further classify fractures of immature bone and so the effects on future growth:

class="wikitable"
colspan="3"|Localisation

!colspan="3"|Morphology

Bone

|Segment

|Type

|Child

|Severity

|Exceptions

1/2/3/4

|1/2/3

|E/M/D

|1-9

|.1/.2

|I-IV

OTA/AO Classification unifying extension

The Orthopaedic Trauma Association Committee for Coding and Classification initially published their classification system covering the whole skeleton in 1996.{{cite journal | title=Fracture and dislocation compendium | author=Orthopaedic Trauma Association Committee for Coding and Classification | journal=J Orthop Trauma | year=1996 | volume=10 | issue=Suppl 1:v–ix | pages=1–154 | pmid=8814583}} In 2006{{cite journal | title=Fracture and Dislocation Classification | author=Orthopaedic Trauma Association | journal=J Orthop Trauma | year=2007 | volume=21 | issue=Suppl | pages=S1–S133 | pmid=18277234 | doi=10.1097/00005131-200711101-00001| s2cid=24535478 | doi-access=free }} they published a revision, unifying the Muller/AO and OTA systems into a single alphanumeric classification, which has been further updated in 2018:{{cite web |title=AO/OTA Fracture and Dislocation Classification Compendium—2018 |url=https://www.aofoundation.org/trauma/clinical-library-and-tools/journals-and-publications/classification |website=AO Trauma |publisher=AO Foundation |access-date=30 September 2022 |language=en}}

class="wikitable"
colspan="2"|Localisation

!rowspan="2"|Region/Bone

|Bone

!|Segment

rowspan="2"|1

|4

|Scapula

5

|Clavicle

3

|4

|Patella

rowspan="3"|5{{cite journal | title=A comprehensive classification of thoracic and lumbar injuries |vauthors=Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S | journal=Eur. Spine J. | year=1995 | volume=3 | issue=4 | pages=184–201 | pmid=7866834 | doi=10.1007/bf02221591|s2cid=2556695 }}

|1

|Cervical spine

2

|Thoracic spine

3

|Lumbar spine

rowspan="2"|6

|1

|Pelvic ring{{cite book | title=Fractures of the Pelvis and Acetabulum | publisher=Williams & Wilkins | author=Tile M | year=2003 | location=Philadelphia}}

2

|Acetabulum{{cite journal | pmid=14239854 | title=Fractures of the acetabulum: classification and surgical approaches for open reduction |vauthors=JUDET R, JUDET J, LETOURNEL E | journal=J Bone Joint Surg Am |date=Dec 1964 | volume=46 | pages=1615–46| doi=10.2106/00004623-196446080-00001 }}

rowspan="9"|7{{cite journal | title=AO Classification of fractures of the hand bones |vauthors=Petracić B, Siebert H | journal=Handchir Mikrochir Plast Chir |date=Jan 1998 | volume=30 | issue=1 | pages=40–44 | pmid=9541837}}

|1

|Lunate

2

|Scaphoid

3

|Capitate

4

|Hamate

5

|Triquetrum and Pisiform

6

|Trapezium and Trapezoid

7

|Metacarpus

8

|Phalanges

9

|Multiple fractures

rowspan="8"|8{{cite journal | pmid=15315874 | title=Integral classification of injuries (ICI) to the bones, joints, and ligaments— application to injuries of the foot |vauthors=Zwipp H, Baumgart F, Cronier P, Jorda E, Klaue K, Sands AK, Yung SW | journal=Injury |date=Sep 2004 | volume=35 | issue=Suppl 2 | pages=SB3-9 | doi=10.1016/j.injury.2004.07.008}}

|1

|Talus

2

|Calcaneus

3

|Navicular

4

|Cuboid

5

|Cuneiforms

7

|Metatarsus

8

|Phalanges

9

|Multiple fractures

rowspan="2"|9

|1

|Craniomidface{{cite journal | title=A comprehensive classification of craniofacial fractures: postmortem and clinical studies with two- and three-dimensional computed tomography |vauthors=Buitrago-Téllez CH, Schilli W, Bohnert M, Alt K, Kimmig M | journal=Injury |date=Oct 2002 | volume=33 | issue=8 | pages=651–68 | pmid=12213415 | doi=10.1016/s0020-1383(02)00119-5}}

2

|Mandible{{cite book | title=AO Classification of Mandibular Fractures | publisher=Springer-Verlag | editor=Spiessl B | year=1989 | location=Berlin}}

References

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