Fracture Classification and Types

The clinician managing fractures applies evidence-based classification systems for treatment planning, determines operative vs non-operative management, prescribes perioperative optimization, and manages long-term complications including nonunion and pathological fractures. Key classification systems beyond Gustilo-Anderson include: Salter-Harris classification for pediatric physeal fractures (Type I: through physis only; Type II: through physis and metaphysis (most common, 75%); Type III: through physis and epiphysis into joint; Type IV: through metaphysis, physis, and epiphysis; Type V: crush injury to physis (worst prognosis for growth arrest)). Garden classification for femoral neck fractures (I: incomplete/valgus impacted; II: complete, non-displaced; III: complete, partially displaced; IV: complete, fully displaced). AO/OTA fracture classification provides a comprehensive alphanumeric system for all fractures. The clinician determines operative indications: displaced intra-articular fractures, unstable fracture patterns, associated neurovascular injury, open fractures, failed closed reduction, and pathological fractures requiring stabilization. For hip fractures, the clinician must understand that femoral neck fractures in elderly patients are treated differently from intertrochanteric fractures: displaced femoral neck fractures in elderly patients are best treated with arthroplasty (hemiarthroplasty or total hip replacement) because the femoral head blood supply is disrupted,...