Penyaji :dr. Raymonddr. Nizardr. Ivan Kurniawandr. Rinaldi Syahputra

Pembimbing :dr. Muzakkie, SpBO

The ConceptFirst PublishedThe observer was offered a choice from a progressive sequence of 3 options, relative to each of 3 bone segment: 1. Type2. Group3. Sub-Group

Muller at al:-Introduced binary concept- Goes beyond th mere production of an an alpha numeric coding:* recognize* identify* describeThe Injury to the bone

The discipline of alpha numeric notation:*serve to guide*record & store*description of the fracture which needed to permit good decision makingin the light oh the structuredobservation required by the classificationprotocol and as well as to generate the code

The principles*The classification of the fractures is organised in order of increasing severity, according to the morphological complexity, the difficulty of treatment and the prognosis*A1 indicates the simplest fracture with the best prognosis

*C3 the most difficult with the worseprognosis*The sub groups represent threecharateristic variations within the group

Coding the diagnosis*To code the diagnosis of fracture, one must know its location and itsmorphology

Location*This is designated by two numbers- which bone?1. humerus2. radius/ulna3. femur4. tibia/fibula- which segment? 1.Proximal2.Diaphyseal 3.Distal4.Malleolar

*The proximal and distal segments of long bones are defined by a square whose sides are the same length as the widest part of the epiphysis.Exceptions: Proximal humerus (11), Proximal femur (31) and Malleolar fractures (44)*If the fractures is associated only with an undisplaced fissure which reaches the joint, it is classified as metaphyseal or diaphyseal depending on where its center is

*For coding, the alpha-numeric format is used to conform with computing practice, the key which unlocks this fractures classification is accurate description*Each bone or bone region is numbered and the long bones are each divided into three segments

The MorphologySimple or multifragmentary

SIMPLE : to characterize a single circumferential disruption of a diaphysis or metaphysis or an articular surface.includes spiral, oblique or transverse fracture

MULTIFRAGMENTARY :to characterize any fracture with one or more completely separated intermediate fragmentsincludes the wedge and the complex fracture

WEDGE FRACTURE : A fracture with one or more intermediate fragments in which after reduction, there is some contact between the main fragments.

COMPLEX FRACTURE :A fracture with one or more intermediate fragments in which after reduction there is no contact between the main proximal and distal fragments.Includes spiral, segmented or irreguler

The term comminuted is imprecise and should not be used

Fractures of the proximal and distal segments : extra-articular articular

EXTRA ARTICULAR FRACTURES : do not involve the articular surface although they may be intracapsular include apophyyseal & metaphyseal fractures

ARTICULAR FRACTURES : involve articular surface subdivided into partial & complete

PARTIAL ARTICULAR FRACTURES : Involve only part of the articular surface while the rest of that surface remains attached to the diaphysis.

COMPLETE ARTICULAR FRACTURES : The articular surface is disrupted and completely separated from the diaphysis.

pure split : resulting from a shearing force. The direction of the split is usually longitudinal pure depression : depression of the articular surface without a split. The depression may be central or peripheral split-depression : a combination of a split and a depression. The joint fragments are usually separated multifragmentary depression : part of the joint is depressed and the fragments are completely separated

Types of PARTIAL ARTICULAR FRACTURES

Humerus (11-proximal)

Humerus (11-proximal)

Humerus (12-diaphysis)

Humerus (11- proximal)

Humerus (12-diaphysis)

Humerus (12-diaphysis)

Humerus (13-distal)

Humerus (13-distal)

Humerus (13-distal)

Radius/Ulna (21-proximal)

Radius/Ulna (21-proximal)

Radius/Ulna (21-proximal)

Radius/Ulna (22-diaphysis)

Radius/Ulna (22-diaphysis)

Radius/Ulna (22-diaphysis)

Radius/Ulna (23-distal)

Radius/Ulna (23-distal)

Radius/Ulna (23-distal)

Femur (31-proximal)

Femur (31-proximal)

Femur (31-proximal)

Femur (32-diaphysis)

Femur (32-diaphysis)

Femur (32-diaphysis)

Femur (33-distal)

Femur (33-distal)

Femur (33-distal)

Tibia/Fibula (41-proximal)

Tibia/Fibula (41-proximal)

Tibia/Fibula (41-proximal)

Tibia/Fibula (42-diaphysis)

Tibia/Fibula (42-diaphysis)

Tibia/Fibula (42-diaphysis)

Tibia/Fibula (43-distal)

Tibia/Fibula (43-distal)

Tibia/Fibula (43-distal)

Tibia/Fibula (44-malleolar segment)

Tibia/Fibula (44-malleolar segment)

Tibia/Fibula (44-malleolar segment)