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Today's VeTerinary PracTice | July/august 2015 | tvpjournal.com a PracTiTioner's Guide To FracTure ManaGeMenT Peer reviewed 20 fractures must be correctly identifed and classifed. Fractures are initially classifed by anatomic location, such as articular, physeal, epiphyseal, metaphyseal, or diaphyseal (Figure 2). Certain fractures are further subclassifed based on anatomic locations, such as condylar, supracondylar, trochanteric, or subtrochanteric. Based on radiographs, fractures are classifed by severity, such as: • Incomplete: Fracture through only one cortex • Complete: Fracture through both cortices • Comminuted: Multiple fragments (Figure 3) • Segmental: Two or more separate fractures. The term compound fracture is no longer used for fracture classifcation. Typical fracture patterns consist of: • Transverse: Fracture is perpendicular to axis of the bone and is the diameter of the bone • Oblique: Fracture is diagonal to axis of the bone » Short oblique: Fracture is < 2× the diameter of the bone » Long oblique: Fracture is > 2× the diameter of the bone (Figure 4 ). • Spiral: Oblique fracture with a twist • Avulsion: Fractures classified as either: » Enthesis: Fracture at attachment of a joint capsule » Apophysis: Fracture at origin or insertion of a tendon or ligament; an example of an apophysis fracture is an olecranon fracture (Figure 5) • growth plate: See Salter Harris Fractures. Displacement should also be recognized when classifying fractures; full orthogonal radiographs are needed to fully characterize displacement. This property is based on the degree of displacement of the distal segment in relation to the proximal segment. An example is caudoproximal displacement, which is seen with most distal diaphyseal femoral fractures. Further classifcation of fractures should incorporate level of contamination—whether the fracture is closed (intact skin) or open. Open fractures are further subclassifed as: • Type I: < 1 cm puncture; fragment briefly penetrated the skin FIGURe 2. Anatomic classifcation of long bones helps describe fracture location. FIGURe 3. Lateral radiograph of mid-diaphyseal right comminuted femoral fracture due to trauma associated with a bullet (a). Craniocaudal radiograph of same femoral fracture (b). When both views are compared, caudoproximal and medial displacement can be seen. Note markers indicating right or left are not present; they were cropped out for magnifcation purposes, but should always be included in radiographs. FIGURe 4. Classifcation of transverse, short oblique, and long oblique fractures of a femur. a b