Clasificacion OTA Completa

INTRODUCTION
Fracture and Dislocation Classification

Compendium - 2007
Orthopaedic Trauma Association
Classification, Database and Outcomes Committee
J.L. Marsh, MD,* Theddy F. Slongo, MD, Julie Agel, NA, ATC, J. Scott Broderick, MD,
William Creevey, MD,! Thomas A. DeCoster, MD, Laura Prokuski, MD,# Michael S. Sirkin, MD,**
Bruce Ziran, MD, Brad Henley, MD, Laurent Audig, DVM, PhD
Summary: The purpose of this new classification compendium is to
republish the Orthopaedic Trauma Associations (OTA) classification.
The OTA classification was originally published in a compendium of
the Journal of Orthopaedic Trauma in 1996. It adopted The
Comprehensive Classification of the Long Bones developed by Mller
and colleagues and classified the remaining bones. In this compendium, the introductory chapter reviews new scientific information
about classifying fractures that has been published in the last 11 years.
The classification is presented in a revised format that is easier to follow. The OTA and AO classification will now have a unified alphanumeric code eliminating the differences that have existed between
the 2 codes. The code was significantly revised for the clavicle and
scapula, foot and hand, and patella. Dislocations have been expanded
on an anatomic basis and for most joints will be coded separately. This
publication should stimulate new developments and interest in a unified language to code and classify fractures. Further improvements in
classification will result in better patient care and clinical research.
J Orthop Trauma 2007;21(Suppl.): S1-S133
THE RATIONALE FOR REPUBLISHING

The Orthopaedic Trauma Association (OTA) fracture
classification was published in a compendium of the Journal of
Orthopaedic Trauma (JOT) in 1996.1 It adopted The
Comprehensive Classification of Fractures of the Long
Bones developed by Mller and collaborators,2 classified bones
that had not been previously classified and revised the alphaFrom the *Department of Orthopaedics and Rehabilitation, The University of Iowa
Hospitals and Clinics, Iowa City, IA; Department of Paediatric Surgery,
Paediatric Trauma and Orthopaedics, University Children's Hospital, Bern
Switzerland; Department of Orthopaedics, Harborview Medical Center, Seattle,
WA; Greenville University Medical Center, Greenville, SC; !Department of
Orthopaedic Surgery, Boston University Medical Center, Boston, MA;
Department of Orthopaedics and Rehabilitation, University of New Mexico,
Albuquerque, NM; #University of Wisconsin, Madison, WI; **Department of
Orthopaedics, New Jersey Medical School, Newark, NJ; Orthopaedic Trauma,
St. Elizabeth Health Center, Orthopaedic Surgery Northeast Ohio Universities
College of Medicine, Youngstown, OH; AO Clinical Investigation and
Documentation, Dbendorf, Switzerland
Disclosure: Dr. Henley is a consultant for Zimmer. The remaining authors report
no conflicts of interest.
Material presented in this Compendium is based on the Comprehensive
Classification of Fractures of Long Bones, by M.E. Mller, J. Nazarian, P.
Koch and J. Schatzker, Springer-Verlag, Berlin, 1990. The Orthopaedic
Trauma Association is indebted to Professor Maurice Mller for allowing the
Association to use the system.
Correspondence: JL Marsh, MD, Department of Orthopaedics and Rehabilitation,
The University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01071 JPP,
Dept. of Orthopaedics, Iowa City, IA 52242 (e-mail: j-marsh@uiowa.edu).
Copyright 2007 by Lippincott Williams & Wilkins
numeric code developed by the Mller group. In their introduction to the 1996 compendium, the Coding and Classification
Committee noted that the goal of the comprehensive classification was to classify fractures in a uniform and consistent fashion to allow standardization of research and communication.1
The committee observed that the current state of fracture classification was ineffective for these purposes with multiple diverse systems used in different parts of the skeleton for various
purposes, thwarting any possibility of a standardized language
and accumulation of uniform data. Their intent was for the new
classification to be a flexible, evolving classification system in
which changes would be made based on comment, criticism
and appropriate clinical research. In this way the classification
could continue to optimally serve the needs of orthopedic traumatologists for both clinical practice and research.
Since the compendium was published in 1996, the classification has resided on the OTA website and has been regularly
used in trauma databases in North American Trauma Centers. It
is the official classification of the OTA and of the JOT. In these
ways it has developed wide acceptance and has dramatically improved the way information about fractures is communicated,
stored, and used to advance knowledge through clinical research. In some anatomic areas this classification has largely
supplanted all others, achieving one of the original intents.
Unfortunately, the OTA classification has not achieved
some of its originally stated goals. It has not been modified
since 1996 and therefore it has not been the flexible, evolving classification envisioned when it was published. It also
has not become a truly universal language of communication
because multiple other anatomically specific classifications
still exist and are part of commonly used fracture language,
and for some areas of the skeleton they are still preferred.
Since 1996, considerable new scientific information has
been published about fracture classification in general and the
OTA system in particular. Factors leading to poor reliability
and reproducibility of fracture classifications have been intensively studied. These studies have led to important new information on how clinicians interpret images of fractures on
radiographs and the process by which fractures are classified.
Unfortunately, difficulties with classification reliability have
led to some loss of enthusiasm with the classification process.
It is now widely recognized that, to ensure that any classification is suitably reliable, it must undergo an intense and rigorous scientific scrutiny. The effort required is considerable,
and this difficult process has either been ignored or avoided
in favor of popular and widely used classifications.
J Orthop Trauma Volume 21, Number 10 Supplement, November/December 2007
S1
Introduction
Journal of Orthopaedic Trauma Volume 21, Number 10 Supplement, November/December 2007
The purpose of this new classification compendium is to

republish the OTA classification. There are many reasons to do
this. It will further a cohesive collaboration between the OTA
Classification, Database and Outcomes Committee and the
Arbeitsgemeinschaft fr Osteosynthesefragen Classification
Task Force (AO/CTF) group and will publish the unified coding agreed upon by the two groups (Fig. 1). This will further
the original goal of developing an internationally recognized
uniform means to communicate about and perform clinical research on fractures and dislocations. This introductory chapter discusses the advantages and disadvantages of the uniform
classification as it has existed for the past 10 years, reviews
new scientific information on fracture classification, highlights the successes that have been realized, summarizes the
drawbacks to systematic classification of fractures, and describes the process the OTA Classification, Database and
Outcomes Committee has gone through to modify the existing classification and adopt a new uniform alpha-numeric
code as proposed by the AO/CTF group.
FUNDAMENTALS OF FRACTURE
CLASSIFICATION
Classification is the process by which related groups are
organized based on similarities and differences.3 It condenses
the language necessary to convey information among individuals with a similar understanding of the classification. A
broad and diverse topic such as fractures lends itself well to
the classification process. We all classify fractures as part of
our standard description of an injury. In describing a fracture,
we identify a bone, define a region in the bone, and routinely
describe displacement and comminution and location of fracture lines with respect to relevant anatomy. In these ways we
are verbally classifying the fracture as we describe it. Formal
classification of fractures systematizes this descriptive
process and replaces words with categories and numbers or
letters that convey the same information. Fracture classification allows information about fractures to be stored in a way
that facilitates comparisons among different groups or among
similar groups treated differently.
A good fracture classification fulfills some fundamental
objectives. It should provide a reliable and reproducible
means of communication. Different observers (reliability) or
the same observer on repeated viewings (reproducibility) presented with the same material (for example, a radiograph)
must agree on the classification of a fracture a high percentage of the time. If this is not the case, the classification has
failed in its fundamental goala means to communicate information based on agreed similarities and differences.
There should be clear clinical relevance for the groups
within the classification that relate either to treatment guidelines, to prognosis, or to risk for complications. Without clinical relevance there is no good reason to define and separate
different groups. To ensure that this relevance is present,
prospective clinical research is necessary. Generally speaking,
the hierarchy of a classification should proceed from less severe (as defined by energy of injury, difficulty of treatment, or
patient outcome) to more severe, because classification is the
fundamental way to convey information about injury severity.
Another type of hierarchy used in both the OTA and the AO
classification organizes fractures within a class from less to
S2
more detailed injury descriptions. This enables a rater to utilize the appropriate complexity to suit his or her purposes.
This characteristic is relatively unique to this classification but
its utility has not been widely employed in the past 11 years.
Most good fracture classifications are organized with these hierarchies. Ideally, a classification should be all-inclusive (all
fractures within reason in a given region should be included)
and mutually exclusive (a given fracture should fit in only one
category). Finally, a classification should be logical, comprehensible, and should not contain an unmanageable number of
categories, a problem that ensures poor reliability.4
Many different characteristics of fractures have been
used as the basis of fracture classification systems. Most classifications, such as the OTA classification, are based on the
anatomic location and the morphology of the fracture.1 These
features can simply be observed or formal measurements may
be necessary. Most commonly the observations and measurements are made on radiographs but in some circumstances information obtained on physical exam, history or
intra-operative findings is considered as part of the classification process. Other features of a fracture, such as the mechanism of injury or associated injuries, may be used in
determining how the fracture should be classified.5 Unless the
information necessary to classify a fracture and how this information is assessed are precisely defined, observers will use the
classification in different ways and reliability will suffer.
To serve the purposes of populating large trauma databases, such as those used at many major trauma centers, and to
provide a space efficient shorthand across languages, a standardized alpha-numeric code for all fractures is necessary and
has always been a part of this system, another relatively
unique feature. Site-specific classifications must be replaced
with a systematic, orderly classification system that encompasses fractures of the entire skeleton. This is absolutely necessary for multi center collaboration, retrospective comparison
of results, international communication and for ease of accomplishing the task of recording information about all fractures in
a trauma database. Although site-specific research is possible
without a comprehensive classification, the more one system
is used consistently for all purposes, the closer we come to a
uniform universal language for fracture care. We believe that
this is a goal that continues to be worth pursuing and is one of
the fundamental advances of the comprehensive classifications of Mller at al2 and the OTA classification.1
ADVANTAGES OF A COMPREHENSIVE
CLASSIFICATION OF FRACTURES
The publication of the English edition of The Comprehensive Classification of Fractures of Long Bones by Mller at
al in 1990 and the subsequent publication of the OTA classification in the 1996 JOT compendium were landmark advances
in fracture classification compared to the state of the art that
was current at that time.1,2 Before these publications, a systematic classification of fractures throughout the skeleton was not
available. Eponyms were rampantColles fracture is an example used to designate diverse patterns of distal radius fractures
variably including intra-articular and extra-articular patterns,
partial and total articular comminution, and variable amounts
of angulation and displacement. Trauma databases were essentially not possible. Classifications were developed by individ 2007 Lippincott Williams & Wilkins
ual investigators to suit their own purposes and were widely

disseminated not only in publications but in book chapters and
other non scientific works. There was no uniform language that
related to injury severity. Some of the terminology of these
classifications has now become commonplace, such as partial
and total articular fractures.
The vision of Mller and colleagues and the collaboration of the OTA dramatically changed the field of fracture
classification.1,2 These widely adopted classifications are now
used internationally and have partially achieved a universal
language for fracture communication. They are all-inclusive
with all bones and all fractures included, and each category,
with only a very few exceptions, is mutually exclusive. They
include common criteria (extra-articular, partial articular,
total articular) throughout the skeleton, which makes it possible for even relatively inexperienced practitioners to achieve
the basics of using the classification at the type and group
level. However, experience has shown that this should not be
pushed to an extreme because certain areas of the skeleton are
amenable and others are not. For this reason, in some
anatomic areas in this revision we have used criteria that are
anatomically specific and clinically relevant.
Another advantage of the comprehensive classifications
is that there are clear definitions of the various groups and subgroups. For example, the localization within a long bone is defined by the rule of squares to define the three areas in the bone
(proximal, shaft, distal).2 This may appear simplistic, but most
other commonly used classifications do not adequately define
the fracture types or groups or even what fractures belong in the
classification. For example, the Schatzker classification is of
proximal tibia fractures but fails to define how a proximal tibia
fracture should be distinguished from a shaft fracture.6
Therefore, not only is there uncertainty within the groups but
exactly which fractures are chosen to be classified and which
ones are not is not clearly communicated. Investigators are free
to use the classification in whatever way suits their purpose.
There have also been criticisms of the comprehensive
classification systems and areas in which the original goals
have not been achieved. With 27 subgroups in each of the
areas, it is easy to conclude that it is too complex and overwhelming for the average user. As the complexity increases
observer reliability decreases. Although these concerns are
valid, one of the advantages of the design of this classification
is that it lends itself to use of as much or as little of the increasing complexity of the types, groups, and subgroups as is
needed for a given purpose or a given user. For example, research projects may require more detail, whereas routine
database entries may have less detail. Another problem is that
many of the criteria that distinguish among groups and subgroups may be of unknown or little clinical significance, rendering the complexity of the classification of minimal value.
Further clinical research is necessary to refine groups into
those that have maximal clinical significance for either treatment techniques, risks of complications, or clinical outcomes.
FRACTURE CLASSIFICATION: ISSUES WITH

OBSERVER RELIABILITY
The importance of careful scrutiny of the observer reliability of fracture classifications became increasingly apparent in the early 1990s and remains a major issue for fracture
2007 Lippincott Williams & Wilkins
Introduction
classification. The language and assumptions we use to group

fractures was seriously questioned, and the lessons learned
continue to be of utmost importance today. In a 1993 publication in the Journal of Bone and Joint Surgery, Siebenrock and
Gerber assessed the observer reliability of the Neer classification of proximal humerus fractures.7 This important classification was and still is one of the most commonly used
classifications in fracture care. It fulfills many of the goals of
a good classification because it provides a way to communicate critically important information about proximal humerus
fractures. Decisions on treatment and determinants of outcome are based on categories determined by defining the relationships between four typical fracture parts of the proximal
humerus. Unfortunately this important work demonstrated
that the observer reliability of this classification was much
poorer than expected. This data created a wave of controversy, with many surgeons criticizing the data and the methods. However, further publications on the Neer and many
other fracture classifications have demonstrated that the use
of categorical classifications is generally not highly reliable,
and that these problems must be acknowledged and the issues
that lead to them carefully studied.812 The fact that reliability is far less than perfect in many common fracture classifications is no longer a disputed issue.
The reasons for poor reliability have been extensively investigated, and together these investigations constitute a significant body of work produced over the past 10-14 years.
Investigators have studied the effect on classification reliability
of clinician experience,811 complex imaging studies,8,1215
traced lines on radiographs,16 multiple radiographic views,10,17
number of categories,8,1822 binary decision making,23 ability
to measure displacements,24,25 and to determine basic fracture
assessments (comminuted or not; displaced or not).24 These investigations have demonstrated that even under the most ideal
conditions with experienced clinicians, clear group definitions,
and excellent imaging studies, observer disagreement still occurs. It can be decreased but not eliminated.
There are many reasons for observer disagreement in
classifying fractures. Some of them can be improved through
validated development of a classification and determining categories but others present limitations to the degree that observer
reliability can be achieved with categorical classifications.
Observers have inherent biases based on their personal experiences that lead them to different conclusions on the basis of the
same information. Even without this bias they make errors such
as failing to see a fracture line that others agree is present.26
These problems are inevitable and cannot be overcome. Another
fundamental issue is that fracture classification is in many ways
an assessment of injury severity. Classifying a fracture and
therefore its severity places it within a specific category whereas
in reality fracture severity occurs on a continuous spectrum.21,27,28 Some injuries are on the border between one category and another, making observer disagreement inevitable.
Despite these issues, observer reliability is better in some
circumstances than in others and for some classifications than
for others. Not surprisingly most studies have shown that experienced clinicians usually classify fractures more reliably than
less experienced clinicians, although the effect is variable in different studies.911 Reliability can be improved by modifications
of existing classifications or during the development of new
classifications by a systematic methodological approach.29
S3
Introduction
Through these methods, problems that are now known to increase observer error and disagreement can be readily identified
and minimized as much as possible. Categories within a classification should be as discrete as possible because less discrete
categories lead to wide gray zones and thus increase observer
disagreement. For example, if a category is defined by asking if
a fracture line enters the articular surface, a clear judgment can
be made. However, if the category is defined by the presence or
absence of fracture comminution, this less clear assessment
(how is comminuted defined?) increases the chances for disagreement.24 Similarly, subjective assessments perform poorly,
such as a category defined by a high energy mechanism especially without definition of what this phrase means.24 To the extent possible, categories should be uniquely defined. As an
example, assessing whether the physis is either involved with a
fracture or is not is a more uniquely defined assessment than
whether the fracture is angulated or not. The latter leaves room
for various interpretations of angulation. If measurements are
used to define categories the degree of error in measuring must
be considered and minimized. For example, the degree of displacement of the articular surface in millimeters has been shown
to have high observer error, which means that this commonly
used assessment is a poor way to define categories.24,30 Some
measurements are impossible to make. A category defined as
greater or less than 1 centimeter of displacement between fragments (eg, the greater tuberosity from the rest of the humerus)
requests an observer to measure something on radiographs that
are often exposed in a plane that makes this measurement impossible, relegating the assignment of a fracture category to a
guess unless multiple, carefully exposed radiographs in various
degrees of rotation are evaluated.17 Moreover, categories are
sometimes defined according to a pre-defined cut-off regarding
a continuous diagnostic parameter. For example, the obliquity
of diaphyseal fractures is reduced to a dichotomous variable
(! 30 vs " 30) in the comprehensive long bone classification.
Any such cut-off values ideally should be chosen so that they
are reliably measured and clinically important, but this may not
be the case.
The Comprehensive Classification developed by Mller
at al and modified and adopted by the OTA has not been immune to these problems with observer reliability.1,2 Studies in
the distal radius, distal tibia, proximal tibia, proximal
femur8,1822 and elsewhere have demonstrated that the observer
reliability of the system falls off significantly between the type
and group level and again at the group to subgroup level. It has
generally been conceded that for the purposes of clinical research it has excellent reliability only at the type level.20,21
NEW INITIATIVES IN CLASSIFICATION

OVER 10 YEARS
There have been initiatives in fracture assessment designed to improve classification rather than merely to define
problems.25 The rank order method has been used in studies in
other clinical areas where categorical classification has proved
to be difficult.27 To avoid problems with classification,
Buckwalter et al assessed residents clinical performance by
having faculty rank them in relation to each other and then correlated the rankings with in-training exam scores.31 They found
high levels of faculty agreement for relative ranks of resident
performance indicating that the rank order method was an excel-
S4
lent substitute for classification. As problems with categorical

classification of fractures became apparent, rank order methods
have been applied to fractures. This method avoids the problem
with reliability that occurs when a continuous variable, such as
fracture severity, is arbitrarily assigned to categories. Instead, a
number of fractures are ranked in relation to each other by experienced clinicians for severity or for any variable of interest.
DeCoster et al and Williams et al have demonstrated that the
rank order method to assess fracture severity leads to high levels of observer agreement in the relative rank between
cases.27,28 This indicates that observers agree on the relative
order of injury severity but when asked to assign categories they
have much greater disagreement. In both of these studies, the
rank order method was used to predict clinical outcomes.27,28
Unfortunately, this method is only amenable to use within a defined series of patients because the results cannot be transposed
out of the series. It therefore has applicability only for research
purposes where it can be used as a more reliable way to assign
relative severity than classification. Nork et al have recently
used this method to assess injury severity in a series of bicondylar tibial plateau fractures and have applied the results to determine factors that predict outcome after treatment.32
Considering the problems with previous classifications
another new initiative in fracture classification has been developed by the AO/CTF group, which has been working on several site-specific projects to develop new classifications using a
systematic methodology in three phases.33 The first development phase involves clinical experts developing proposals for
the classification system, as well as defining the classification
process. This phase is related solely to diagnostics and defines
a common language with which surgeons should be able to
identify and classify fractures similarly. Successive pilot agreement studies are conducted to ensure that clinical experts can
do this, and if they cannot, the proposed system and classification process is appropriately changed and reevaluated. Such a
systematic process has been applied for the development of a
pediatric long bone classification with very encouraging results.34 An innovative approach using latent class modeling for
the analysis of classification data has been proposed, particularly when an acceptable reference standard classification
process is lacking.35 The second phase involves a multicenter
agreement study to ensure that future users with less clinical
experience can also classify fractures similarly. Depending on
the results, some modifications toward improvement of the system may still be proposed.36,37 This creates the basis for a reliable classification tool to be used in the context of prospective
clinical studies for evaluation of fracture treatment options and
outcomes in a third validation phase.
The AO/CTF group and the OTAs Classification, Database and Outcomes Committee are collaborating in the development, validation, and promotion of clinically relevant and
widely accepted classification systems. Internationally recognized classification review groups for different body sites are
being created as an important step forward. Modifications of
new and existing systems should be evidence-based, ie, proposed and supported on the basis of solid validation data.
The AO/CTF group has also integrated approved classification systems into a software named AO COIAC (AO
Comprehensive Injury Automatic Classifier) to support teaching and to facilitate diagnosis and coding of injuries. A skeleton interface provides access to one of several area-specific
A Mller-AO classification system
Introduction
B OTA classification system
C New
unified classification
Figure
2: Proposal
for a unifiedsystem
numbering AO/OTA system
FIGURE 1. Designation of bone location
classification modules. Drawing fracture lines or clicking

with the mouse on standard bone drawings aids the classification process for the user, with successive drop-down menus
and classification options. Data can be saved in a relational
database and exported for further analyses and presentations,
or printed for the patients files. For each injury the classification data can be collected by several different surgeons
and/or at different times, hence supporting research and validation efforts.33 The groups initial publications have been on
a pediatric long bone classification.34
THE PROCESS OF REVISING THE COMPENDIUM

At the time of the original publication of the OTA classification the committee classified additional bones that were not
included in the original Comprehensive Classification proposed

by Mller et al.1,2 This led the committee to make some changes
in the overall numeric code which over the past 10 years resulted in two somewhat different codes, one used by the AO and
one by the OTA. For example, in the original AO system clavicle was 91.2 and in the OTA system it was 06, patella 91.1 AO
and 34 OTA, and the wrist and hand were 7 in AO and 24, 25
and 26 for OTA. In early 2006 the AO/CTF group proposed a
new unified numbering scheme to replace both of the previous
versions. This proposal was considered and then accepted by the
Classification, Database and Outcomes Committee of the OTA.
Now clavicle (15), scapula (14), patella (34), hand (7), and foot
(8) will be the same for both groups. Through this agreement
there is now one universal alpha-numeric code that promotes the
concept of a universal language for fractures. The original AO
S5
Introduction
and OTA numbering schemes and the new unified numbering

scheme are reproduced in Figure 1 A-C. The body of this compendium uses the new unified alpha-numeric code. There are no
changes to the long bone sections (humerus, radius and ulna,
femur, and tibia) originally published by Mller et al,2 which
further promotes a unified fracture code accepted universally by
both groups.
In addition to accepting and incorporating the unified
numbering format, other revisions of the OTA classification
were produced with the help of member volunteers from the
organization. Members participating were asked to independently review assigned sections of the classification and to
make suggestions for improvement in language, descriptions,
style and format. All suggestions were collated anatomically
and then reviewed by the Classification, Database and
Outcomes Committee at a full day meeting. Committee members submitted additional suggestions. All suggestions from
the member volunteers and committee members were individually considered. Extra consideration was given to suggestions that were received from multiple individuals.
After discussion, if the committee unanimously agreed
that suggested revisions were improvements, they were
adopted and included in this volume. The major change that is
immediately apparent relates to format, where many members
suggested and the committee agreed that all groups (A,B,C)
should be presented on the same page rather than split as in the
1996 publication. The long bone sections 14 were not
changed. The advantages of addressing difficulties with language and categories identified in these areas by OTA members and the committee were offset by the important goal of
furthering a unified international fracture language. The sections other than long bone (14, 15, 58) were updated. We
have made extensive revisions to the foot and carpus.
Metacarpal and metatarsal and phalanges are now exactly
aligned in both the foot and the hand. Dislocations were expanded on an anatomic basis and designated with a zero code
in the second digit. Dislocations will be coded separately

(other than in the pelvis, forearm, and talus), and this section
has been completely revised.
A new part of the classification, the pediatric long bone
classification, has been incorporated directly from the work
of the AO/CTF group and is the result of their meticulous scientific effort. We sincerely hope that future republications of
the OTA classification will be able to incorporate additional
changes resulting from this type of rigorous scientific method
and will therefore need to depend less on committee review.
SUMMARY
Since the original publication of the OTA Fracture
Classification in the 1996 JOT Compendium, there has been
important progress in fracture classification. We are farther
along toward the goal of a universally accepted fracture language, but more progress remains to be made. New knowledge has helped us to understand how classifications work, or
sometimes do not work. Much of this new knowledge has
been enlightening; some of it has highlighted areas in which
additional work is necessary. Advances in fracture care are
possible only through an organized grouping of the pathology
presented by the myriad of fracture patterns and associated injuries. Republication of the OTA classification in this compendium combined with advances in fracture classification
software and scientific methodology by the AO/CTF group,
will serve to further this goal. We hope to reinvigorate interest in the language we use to communicate and record information about fractures and dislocations, because it is only
through this language that we can collectively learn from our
experiences to provide better care for future fracture patients.
We encourage those interested in fracture care to utilize this
classification and to participate in further classification improvements that will lead to the publishing of yet another improved version 10 years from now.
Listing of references can be found on page S133.
Introductory Message from the AO Classification Supervisory Committee

The AO Classification Supervisory Committee welcomes the
opportunity to participate with the Orthopaedic Trauma
Association (OTA) in the revision of the Compendium on
Fracture Classification. The original cooperative effort on this
Compendium was started to standardize the classification system for fractures based upon the work of Maurice Mller
through the Comprehensive Classification of Fractures. The
collaboration of AO with the OTA ensured that this system has
a basic worldwide readership and distribution. This opportunity
to attempt to standardize the terminology for fractures and classifications has now led to a revision of the Compendium to deal
with any potential change. Two major events have occurred.
First, a truly validated classification for pediatric fractures is
now available. This classification has gone through two critical
stages of internal validation and evaluation and has now been
published in pediatric peer-reviewed journals. This is a major
landmark in the classification literature and development, in
that a classification system has now been validated by accepted
S6
methodology. The OTA and the AO Classification Supervisory

Committee are continuing this work by developing a validated
scapular fracture classification. This has just begun its first
stages of validation. Consequently, it will not appear in this edition of the Compendium but when it has been completed, probably within the next year or year and a half, it will be available
as a supplement. The OTA and AO are firm in their conviction
that all new classifications must be developed on the basis of
broad, internationally recognized expertise and that appropriate
validation and verification by the accepted methodology should
be carried out before publication and use. It is also hoped that
over the next year or two, there will be an attempt to validate
the comprehensive classification.
Dr. Theddy F. Slongo
Chairman of the AO Classification Supervisory Committee
Inselspital
3010 Bern, Switzerland
HUMERUS
Location: Proximal segment (11)
BONE: HUMERUS (1)
Types:
A. Extra-articular, unifocal fracture (11-A)
Groups:
Humerus proximal segment, extra-articular unifocal
(11-A)
1. Avulsion of
3. Non2. Impacted
tuberosity
impacted
metaphysis
(11-A1)
metaphysis
(11-A2)
fracture
(11-A3)
B. Extra-articular, bifocal fracture (11-B)
Humerus, proximal segment, extra-articular bifocal

(11-B)
2. Without
1. With meta3. With
metaphyseal
physeal
glenohumeral
impaction
impaction
dislocation
(11-B2)
(11-B1)
(11-B3)
C. Articular fractures (11-C)
Humerus, proximal segment, articular fractures

(11-C)
1. Articular
3. Articular
2. Articular
fracture with
fracture with
fracture imslight displace- pacted with
glenoment impacted marked dishumeral disvalgus fracture
location
placement
(11-C1)
(11-C3)
(11-C2)
These fractures represent three part fractures, or fracture dislocations by the Neer classification.
S7
Humerus
Subgroups and Qualifications:

Humerus, proximal, extra-articular, unifocal tuberosity (11-A1)
2. Greater tuberosity displaced
1. Greater tuberosity not displaced
(11-A1.2)
(11-A1.1)
(1) superior,
(2) posterior
3. With glenohumeral dislocation

(11-A1.3)
(1) anterior and medial plus posterior
cephalic notch
(2) anterior and medial plus greater
tuberosity
(3) erecta and greater tuberosity
(4) posterior and lesser tuberosity
A1
Humerus, proximal, extra-articular, unifocal, impacted metaphyseal (11-A2)

1. Without frontal malalignment
2. With varus malalignment (11-A2.2)
(11-A2.1)
(1) pure medial impaction
(1) without sagittal malalignment
(2) posterior and medial impaction
(2) posterior impaction
(3) anterior and medial impaction
(3) anterior impaction
3. With valgus malalignment

(11-A2.3)
(1) pure lateral impaction
(2) posterior and lateral impaction
(3) anterior and lateral impaction
A2
Humerus, proximal, extra-articular, unifocal, non-impacted metaphyseal (11-A3)

2. Simple with translation (11-A3.2)
1. Simple with angulation (11-A3.1)
(1) lateral
(2) medial
(3) with glenohumeral dislocation
3. Multifragmentary (11-A3.3)
(1) wedge
(2) complex
(3) glenohumeral dislocation
A3
S8

Humerus, proximal, extra-articular, bifocal, with metaphyseal impaction (11-B1)
2. Medial plus lesser tuberosity
1. Lateral plus greater tuberosity
(11-B1.2)
(11-B1.1)
Humerus
3. Posterior plus greater tuberosity

(11-B1.3)
B1
Humerus, proximal, extra-articular, bifocal, without metaphyseal impaction (11-B2)

1. Without rotatory displacement of
2. With rotatory displacement of the
the epiphyseal fracture fragment
epiphyseal fragment (11-B2.2)
(11-B2.1)
(1) greater tuberosity separated
(2) lesser tuberosity separated
3. Multifragmentary metaphysis plus

one of the tuberosities (11-B2.3)
(1) lesser tuberosity
(2) greater tuberosity
B2
Humerus, proximal, extra-articular, bifocal

1. Vertical cervical line plus greater
tuberosity intact plus anterior medial
dislocation (11-B3.1)
with glenohumeral dislocation (11-B3)

2. Vertical cervical line plus greater
tuberosity fracture plus anterior medial dislocation (11-B3.2)
3. Lesser tuberosity fracture plus posterior dislocation (11-B3.3)

(1) without anterior cephalic notch
(2) with anterior cephalic notch
B3
S9
Humerus
Humerus, proximal, articular fracture with slight displacement (11-C1)

1. Cephalotubercular with valgus
2. Cephalotubercular with varus
malalignment (11-C1.1)
3. Anatomical neck (11-C1.3)

(1) nondisplaced
(2) displaced
C1
Humerus, proximal, articular fracture impacted with marked displacement (11-C2)

1. Cephalotubercular with valgus
2. Cephalotubercular with varus
3. Transcephalic (double profile image

on x-ray) and tubercular, with varus
C2
Humerus, proximal, articular fracture dislocated (11-C3)

2. Anatomical neck and tuberosities
1. Anatomical neck
(11-C3.2)
(11-C3.1)
(1) head impacted
(1) anterior
(2) head not impacted
(2) posterior
3. Cephalotubercular fragmentation
(11-C3.3)
(1) head intact
(2) head fragmented
C3
S10
Location: Diaphyseal segment (12)
BONE: HUMERUS (1)
Types:
A. Simple fracture (12-A)
Groups:
Humerus diaphyseal, simple (12-A)
1. Spiral
2. Oblique
(12-A1)
!30) (12-A2)
(!
Humerus
3. Transverse
"30) (12-A3)
("
B. Wedge fracture (12-B)
Humerus diaphyseal, wedge (12-B)

1. Spiral wedge 2. Bending
(12-B1)
wedge (12-B2)
3. Fragmented
wedge (12-B3)
C. Complex fracture (12-C)
Humerus diaphyseal, complex (12-C)

3. Irregular
1. Spiral
2. Segmental
(12-C3)
(12-C1)
(12-C2)
S11
Humerus

Humerus diaphyseal, simple, spiral (12-A1)
2. Middle zone (12-A1.2)
1. Proximal zone (12-A1.1)
3. Distal zone (12-A1.3)
A1
!30) (12-A2)
Humerus diaphyseal, simple, oblique (!
A2
"30) (12-A3)
Humerus diaphyseal, simple, transverse ("
A3
S12

Humerus diaphyseal, wedge, spiral (12-B1)
2. Middle zone (12-B1.2)
1. Proximal zone (12-B1.1)
Humerus
3. Distal zone (12-B1.3)
B1
Humerus diaphyseal, wedge, bending (12-B2)

B2
Humerus diaphyseal, wedge, fragmented (12-B3)

B3
S13
Humerus
Humerus diaphyseal, complex, spiral (12-C1)

(1) pure diaphyseal
(2) proximal diaphysio-metaphyseal
(3) distal diaphysio-metaphyseal
2. With 3 intermediate fragments
(12-C1.2)
(12-C1.1)
3. With more than 3 intermediate

fragments (12-C1.3)
C1
Humerus, diaphyseal, complex segmental

1. With 1 intermediate segmental
fragment (12-C2.1)
(1) pure diaphyseal
(4) oblique lines
(5) transverse and oblique lines
(12-C2)
2. With 1 intermediate segmental and
additional wedge fragments (12-C2.2)
(1) pure diaphyseal
(4) distal wedge
(5) 2 wedges, proximal and distal

fragments (12-C2.3)
(1) pure diaphyseal
C2
Humerus, diaphyseal, complex irregular (12-C3)

1. With 2 or 3 intermediate
"4cm)
2. With limited shattering ("
fragments (12-C3.1)
(12-C3.2)
(1) 2 main intermediate fragments
(1) proximal zone
(2) middle zone
(3) distal zone
3. With extensive shattering

#4cm)(12-C3.3)
(#
(1) pure diaphyseal
C3
S14

BONE: HUMERUS (1)
Types:
A. Extra-articular fracture (13-A)
Groups:
Humerus distal segment, extra-articular (13-A)
1. Apophyseal
3. Meta2. Metaavulsion (13-A1) physeal
physeal multisimple (13-A2) fragmentary
(13-A3)
Humerus
Location: Distal segment (13)
B. Partial articular fracture (13-B)
Humerus distal segment, partial articular (13-B)

1. Lateral
3. Frontal (13-B3)
2. Medial
sagittal (13-B1) sagittal
(13-B2)
C. Complete articular fracture (13-C)
Humerus distal segment, complete

2. Articular
1. Articular
simple, metasimple,
physeal multimetaphyseal
simple (13-C1) fragmentary
(13-C2)
articular (13-C)
3. Articular,
metaphyseal
multifragmentary (13-C3)
S15
Humerus

Humerus, distal, extra-articular apophyseal avulsion (13-A1)
2. Medial epicondyle, non-incarcerated 3. Medial epicondyle, incarcerated
1. Lateral epicondyle (13-A1.1)
(13-A1.3)
(13-A1.2)
(1) non-displaced
(2) displaced
(3) fragmented
A1
Humerus, distal, extra-articular metaphyseal simple (13-A2)

1. Oblique downwards 2. Oblique down3. Transverse (13-A2.3)
and inwards (13-A2.1) wards and outwards
(2) juxta-epiphyseal
(1) transmetaphyseal
(13-A2.2)
with posterior displacement (Kocher I)
(3) juxta-epiphyseal
with anterior displacement (Kocher II)
A2
Humerus, distal, extra-articular metaphyseal multifragmentary (13-A3)

1. With intact wedge (13-A3.1)
2. With fragmented wedge (13-A3.2)
(1) lateral
(1) lateral
(2) medial
(2) medial
3. Complex (13-A3.3)
A3
S16

Humerus, distal, partial articular lateral sagittal (13-B1)
1. Capitellum (13-B1.1)
2. Transtrochlear simple (13-B1.2)
(1) through the capitellum (Milch I)
(1) medial collateral ligament intact
(2) between capitellum and trochlea
(2) medial collateral ligament ruptured
(3) metaphyseal simple (classic Milch II)
lateral condyle
(4) metaphyseal wedge
(5) metaphysio-diaphyseal
Humerus
3. Transtrochlear multifragmentary
(13-B1.3)
(1) epiphysio-metaphyseal
(2) epiphysio-metaphyseal-diaphyseal
B1
Humerus, distal, partial articular, medial sagittal (13-B2)

1. Transtrochlear simple, through
2. Transtrochlear simple, through the
medial side (Milch I) (13-B2.1)
groove (13-B2.2)
3. Transtrochlear multifragmentary
(13-B2.3)
(1) epiphysio-metaphyseal
(2) epiphysio-metaphyseal-diaphyseal
B2
Humerus, distal, partial articular, frontal (13-B3)

2. Trochlea (13-B3.2)
1. Capitellum (13-B3.1)
(1) simple
(1) incomplete (Kocher-Lorenz)
(2) fragmented
(2) complete (Hahn-Steinthal 1)
(3) with trochlear component
(Hahn-Steinthal 2)
(4) fragmented
3. Capitellum and trochlea (13-B3.3)
B3
S17
Humerus
Humerus, distal complete, articular simple, metaphyseal simple (13-C1)

1. With slight displacement (13-C1.1)
2. With marked displacement
(1) Y-shaped
(13-C1.2)
(2) T-shaped
(1) Y-shaped
(3) V-shaped
(2) T-shaped
(3) V-shaped
3. T-shaped epiphyseal (13-C1.3)
C1
Humerus, distal, complete articular simple metaphyseal multifragmentary (13-C2)

2. With a fragmented wedge (13-C2.2)
1. With intact wedge (13-C2.1)
(1) metaphyseal lateral
(1) metaphyseal lateral
(2) metaphyseal medial
(2) metaphyseal medial
(3) metaphysio-diaphyseal-lateral
(3) metaphysio-diaphyseal-lateral
(4) metaphysio-diaphyseal-medial
(4) metaphysio-diaphyseal-medial
3. Complex (13-C2.3)
C2
Humerus, distal, complete multifragmentary (13-C3)

2. Metaphyseal wedge (13-C3.2)
1. Metaphyseal simple (13-C3.1)
(1) intact
(2) fragmented
3. Metaphyseal complex (13-C3.3)

(1) localized
(2) extending into diaphysis
C3
S18
RADIUS/ULNA
BONE: RADIUS/ULNA (2)
Types:
A. Extra-articular (21-A)
Groups:
Radius/ulna, proximal, extra-articular (21-A)
1. Ulna only
(21-A1)
2. Radius only
(21-A2)
3. Radius and
ulna (21-A3)
B. Articular fracture involving articular

surface of only 1 of the 2 bones (21-B)
Radius/ulna, proximal, articular surface one bone

(21-B)
1. Ulna fractured, 2. Radius frac3. Articular of
tured, ulna inradius intact
1 bone, extratact (21-B2)
(21-B1)
articular of
other (21-B3)
C. Articular fracture involving articular surface of 2 bones (21-C)
Radius/ulna, proximal, articular both bones (21-C)

1. Simple of both 2. Simple of
bones (21-C1)
1, multifragmentary of
other (21-C2)
3. Multifragmentary of
both (21-C3)
S19
Radius/Ulna

Radius/ulna, proximal, extra-articular ulna fractured (21-A1)
2. Metaphyseal simple (21-A1.2)
1. Avulsion of triceps insertion from
olecranon (21-A1.1)
3. Metaphyseal multifragmentary
(21-A1.3)
A1
Radius/ulna, proximal, extra-articular radius fractured (21-A2)

2. Neck simple (21-A2.2)
1. Avulsion of bicipital tuberosity of
radius (21-A2.1)
3. Neck multifragmentary (21-A2.3)
A2
Radius/ulna, proximal, extra-articular, fracture both bones (21-A3)

1. Simple of both bones (21-A3.1)
2. Multifragmentary of 1 bone and
simple of other (21-A3.2)
(1) multifragmentary ulna
(2) multifragmentary radius
3. Multifragmentary of both bones

(21-A3.3)
A3
S20

Radius/ulna, proximal, articular fracture ulna (21-B1)
1. UnifocaI (21-B1.1)
2. Bifocal (21-B1.2)
(1) olecranon 1 line
(2) olecranon 2 lines
(3) olecranon multifragmentary
(4) coronoid process alone
Radius/Ulna
3. Bifocal multifragmentary (21-B1.3)

(1) multifragmentary olecranon
(2) multifragmentary coronoid process
(3) multifragmentary of both
B1
Radius/ulna, proximal, articular, radial fracture (21-B2)

1. Simple (21-B2.1)
2. Multifragmentary without depression (21-B2.2)
(1) nondisplaced
(2) displaced
3. Multifragmentary with depression

(21-B2.3)
B2
Radius/ulna, proximal, articular of 1, extra-articular of other (21-B3)

1. Ulna articular simple (21-B3.1)
2. Radius articular simple (21-B3.2)
(1) radius extra-articular simple
(1) ulna extra-articular simple
(2) radius extra-articular multifragmentary (2) ulna extra-articular multifragmentary
3. Articular multifragmentary
(21-B3.3)
(1) ulna, radius extra-articular simple
(2) ulna, radius extra-articular multifragmentary
(3) radius, ulna extra-articular simple
(4) radius, ulna extra-articular multifragmentary
B3
S21
Radius/Ulna
Radius/ulna, proximal, articular both simple (21-C1)

2. Coronoid process and radial head
1. Olecranon and radial head
(21-C1.2)
(21-C1.1)
C1
Radius/ulna, proximal, articular, both bones, 1 simple the other multifragmentary (21-C2)
1. Olecranon multifragmentary, radial 2. Olecranon simple, radial head multi- 3. Coronoid process simple, radial
head multifragmentary (21-C2.3)
fragmentary (21-C2.2)
head, simple (21-C2.1)
C2
Radius/ulna, proximal, articular multifragmentary both bones (21-C3)

1. 3 fragments both bones (21-C3.1)
2. Ulna, more than 3 fragments
(21-C3.2)
(1) radius, 3 fragments
(2) radius, more than 3 fragments
3. Radius, more than 3 fragments

(21-C3.3)
(1) ulna, 3 fragments
(2) ulna, epiphysio-diaphyseal
C3
S22
Types:
A. Simple (22-A)
Groups:
Radius/ulna, diaphyseal, simple (22-A)
1. Ulna simple,
3. Simple frac2. Radius simradius intact
ple, ulna intact ture both
(22-A1)
bones (22-A3)
(22-A2)
Radius/Ulna
Location: Diaphyseal (22)
B. Wedge (22-B)
Radius/ulna, diaphyseal, wedge fracture (22-B)

3. Wedge
1. Ulna fracture, 2. Radius fracfracture, simture, ulna inradius intact
ple or wedge
tact (22-B2)
(22-B1)
of other bone
(22-B3)
C. Complex (22-C)
Radius/ulna, diaphyseal, complex (22-C)

3. Complex of
1. Complex of 2. Complex of
both bones
ulna (22-C1)
radius (22-C2)
(22-C3)
S23
Radius/Ulna

Radius/ulna, diaphyseal, simple fracture of ulna (22-A1)
2. Transverse (22-A1.2)
1. Oblique (22-A1.1)
3. With dislocation of radial head

(Monteggia) (22-A1.3)
A1
Radius/ulna, diaphyseal, simple fracture of radius (22-A2)

3. With dislocation of distal radioulnar joint (Galeazzi) (22-A2.3)
A2
Radius/ulna, diaphyseal, simple fracture of both bones (22-A3)

(1) without dislocation
(2) with dislocation of radial head (Monteggia)
(3) with dislocation of distal radioulnar joint (Galeazzi)
(based on level of radial fracture)
1. Radius, proximal zone (22-A3.1)
2. Radius, middle zone (22-A3.2)
3. Radius, distal zone (22-A3.3)
A3
S24

Radius/ulna, diaphyseal, wedge fracture of ulna (22-B1)
1. Intact wedge (22-B1.1)
2. Fragmented wedge (22-B1.2)
Radius/Ulna
3. With dislocation of radial head

(Monteggia) (22-B1.3)
B1
Radius/ulna, diaphyseal, wedge fracture of radius (22-B2)

1. Intact wedge (22-B2.1)
2. Fragmented wedge (22-B2.2)
3. With dislocation of distal radioulnar joint (Galeazzi) (22-B2.3)
B2
Radius/ulna, diaphyseal, wedge of 1, simple or wedge of other (22-B3)

(2) with dislocation of radial head (Monteggia)
(3) with dislocation of distal radioulnar joint (Galeazzi)
1. Ulna wedge, simple fracture radius 2. Radial wedge, simple fracture of
(22-B3.1)
ulna (22-B3.2)
3. Radial and ulnar wedge (22-B3.3)
B3
S25
Radius/Ulna
Radius/ulna, diaphyseal, complex fracture

1. Bifocal, radius intact (22-C1.1)
(2) with radial head dislocated
(Monteggia)
of ulna (22-C1)
2. Bifocal with radial fracture (22-C1.2)
(1) radius simple
(2) radius wedge
3. Irregular of ulna (22-C1.3)

(1) radius intact
(2) radius simple
(3) radius wedge
C1
Radius/ulna, diaphyseal, complex fracture

1. Bifocal, ulna intact (22-C2.1)
(2) with dislocation of distal radioulnar
joint (Galeazzi)
of radius (22-C2)
2. Bifocal, ulna fracture (22-C2.2)
(1) simple ulna
(2) wedge ulna
3. Irregular (22-C2.3)
(1) ulna intact
(2) ulna simple
(3) ulna wedge
C2
Radius/ulna, diaphyseal, complex of both bones (22-C3)

1. Bifocal (22-C3.1)
2. Bifocal of 1, irregular of other
(22-C3.2)
(1) bifocal radius, irregular ulna
(2) bifocal ulna, irregular radius
3. Irregular (22-C3.3)
C3
S26
Types:
Groups:
Radius/ulna, distal, extra-articular (23-A)
1. Extra-articular 2. Extra-artic3. Extra-articuulna fracture,
lar, multifragular simple
radius intact
mentary
radius frac(23-A1)
radius fracture
ture, ulna
(23-A3)
intact (23-A2)
Radius/Ulna
B. Partial articular fracture of radius (23-B)
Radius/ulna, distal, partial articular radius (23-B)

1. Partial
2. Partial artic- 3. Partial articular
articular radius, ular radius,
radius, volar rim
sagittal (23-B1) dorsal rim
(reverse Barton,
Goyrand Smith
(Barton)
II) (23-B3)
(23-B2)
C. Complete articular fracture of radius (23-C)
Radius/ulna, distal, complete articular (23-C)

2. Complete
1. Complete
3. Complete
articular radius, articular raarticular rasimple articular dius, simple
dius, multiand metaphysis articular,
fragmentary
metaphyseal
(23-C1)
(23-C3)
multifragmentary (23-C2)
S27
Radius/Ulna

Radius/ulna, distal, extra-articular fracture of ulna (23-A1)
2. Metaphyseal simple (23-A1.2)
1. Ulna styloid process (23-A1.1)
(23-A1.3)
(1) wedge
(2) complex
A1
Radius/ulna, distal, extra-articular fracture of radius, simple metaphyseal and impacted (23-A2)
(1) radioulnar dislocation (fracture of styloid process)
(2) simple fracture of ulnar neck
(3) multifragmentary fracture of ulnar neck
(4) fracture of ulna head
(5) fracture of ulna head and neck
(6) fracture proximal to ulnar neck
1. Transverse, no tilt, but may be
2. With dorsal tilt, oblique fracture up- 3. Volar tilt, oblique upwards and foraxially shortened (23-A2.1)
ward and back (Pouteau-Colles)
ward (Goyrand-Smith) (23-A2.3)
(23-A2.2)
A2
Radius/ulna, distal, extra-articular fracture of radius, multifragmentary (23-A3)

2. With a wedge (23-A3.2)
1. Impacted with axial shortening
(23-A3.1)
A3
S28
Radius/ulna, distal, partial articular fracture of radius, sagittal (23-B1)

1. Lateral simple (23-B1.1)
2. Lateral multifragmentary (23-B1.2)
Radius/Ulna
3. Medial (23-B1.3)
B1
Radius/ulna, distal, partial articular fracture of radius, dorsal rim (Bartons) (23-B2)
1. Simple (23-B2.1)
2. With lateral sagittal fracture
(23-B2.2)
3. With dorsal dislocation of carpus

(23-B2.3)
B2
Radius/ulna, distal, partial articular fracture of radius, volar rim (reverse Bartons, Goyrand-Smith II) (23-B3)
1. Simple with small fragment
3. Multifragmentary (23-B3.3)
2. Simple with larger fragment
(23-B3.1)
(23-B3.2)
B3
S29
Radius/Ulna
Radius/ulna, distal, complete articular fracture of radius, articular simple, metaphyseal simple (23-C1)
1. Posteromedial articular fragment
2. Sagittal articular fracture line
3. Frontal articular fracture line
(23-C1.1)
(23-C1.2)
(23-C1.3)
C1
Radius/ulna, distal, complete articular fracture of radius, articular simple, metaphyseal multifragmentary (23-C2)
1. Sagittal articular fracture line
2. Frontal articular fracture line
3. Extending into diaphysis (23-C2.3)
(23-C2.1)
(23-C2.2)
C2
Radius/ulna, distal, complete articular fracture of radius, multifragmentary (23-C3)

(23-C3.2)
C3
S30
FEMUR
BONE: FEMUR (3)
Types:
A. Trochanteric area (31-A)
Groups:
Femur, proximal trochanteric (31-A)
1. Pertro3. Intertro2. Pertrochanteric simple chanteric
chanteric
(31-A1)
(31-A3)
multifragmentary
(31-A2)
B. Neck fractures (31-B)
Femur, proximal, neck fracture (31-B)

2. Transcer1. Subcapital
3. Subcapital
vical (31-B2)
with slight
with marked
displacement
displacement
(31-B1)
(31-B3)
C. Head fractures (31-C)
Femur, proximal, head fracture (31-C)

1. Split (31-Cl)
3. With neck
2. With defracture
pression
(31-C3)
(31-C2)
S31
Femur

Femur, proximal, pertrochanteric simple (only 2 fragments) (31-A1)
2. Through the greater trochanter
1. Along intertrochanteric line
(31-A1.2)
(31-A1.1)
(1) nonimpacted
(2) impacted
3. Below lesser trochanter (31-A1.3)

(1) high variety, medial fracture line at
lower limit of lesser trochanter
(2) low variety, medial fracture line in diaphysis below lesser trochanter
A1
Femur proximal, trochanteric fracture, pertrochanteric multifragmentary (always have posteromedial fragment with lesser
trochanter and adjacent medial cortex) (31-A2)
1. With 1 intermediate fragment
3. Extending more than 1 cm below
2. With several intermediate frag(31-A2.1)
lesser trochanter (31-A2.3)
ments (31-A2.2)
A2
Femur, proximal, trochanteric area, intertrochauteric fracture (31-A3)

1. Simple oblique (31-A3.1)
2. Simple transverse (31-A3.2)
3. Multifragmentary (31-A3.3)
(1) extending to greater trochanter
(2) extending to neck
A3
S32

Femur, proximal, neck fracture, slight displacement (31-B1)
2. Impacted in valgus 15
1. Impacted in valgus 15
(31-B1.2) (Garden 1/2)
(31-B1.1) (Garden 1)
(1) posterior tilt 15
Femur
3. Nonimpacted (31-B1.3) (Garden 2)
B1
Femur, proximal, neck fracture, transcervical (31-B2)

1. Basicervical (31-B2.1)
2. Midcervical adduction (31-B2.2)
3. Midcervical shear (31-B2.3)
B2
Femur, proximal, neck fracture, sub-capital, nonimpacted displaced (31-B3)

1. Moderate displacement in varus and 2. Moderate displacement with vertiexternal rotation (31-B3.1) (Garden 3) cal translation and external rotation
(31-B3.2) (Garden 4)
3. Marked displacement (31-B3.3)

(Garden 3/4)
(1) in varus
(2) with translation
B3
S33
Femur
Femur, proximal, head fracture, split (31-C1)

1. Avulsion of ligamentum teres
2. With rupture of ligamentum teres
(31-C1.1)
(31-C1.2)
3. Large fragment (31-C1.3)
C1
Femur, proximal, head fracture, with depression (31-C2)

1. Posterior and superior (31-C2.1)
2. Anterior and superior (31-C2.2)
3. Split depression (31-C2.3)
C2
Femur, proximal, head fracture with neck fracture (31-C3)

1. Split and transcervical neck fracture 2. Split and subcapital neck fracture
(31-C3.2)
(31-C3.1)
3. Depression and neck fracture

(31-C3.3)
C3
S34
BONE: FEMUR (3)
Types:
A. Simple (32-A)
Groups:
Femur, diaphyseal, simple fracture (32-A)
1. Spiral (32-A1) 2. Oblique
3. Transverse
30) (32-A3)
30) (32-A2) (
(
Femur
B. Wedge (32-B)
Femur, diaphyseal, wedge fracture (32-B)

3. Fragmented
(32-B1)
wedge (32-B3)
wedge (32-B2)
C. Complex (32-C)
Femur, diaphyseal, complex (32-C)

1. Spiral (32-C1) 2. Segmental
(32-C2)
3. Irregular
(32-C3)
S35
Femur

Femur, diaphyseal, simple spiral (32-A1)
1. Subtrochanteric zone (32-A1.1)
30) (32-A2)
Femur, diaphyseal, simple oblique (
A1
A2
30) (32-A3)
Femur, diaphyseal, transverse (
A3
S36

Femur, diaphyseal, wedge spiral (32-B1)
1. Subtrochanteric zone (32-B1.1)
Femur
Femur, diaphyseal, wedge, bending (32-B2)

B1
B2
Femur, diaphyseal, wedge fragmented (32-B3)

B3
S37
Femur
Femur, diaphyseal, complex spiral (32-C1)

(1) pure diaphyseal
(32-C1.2)
(32-C1.1)

fragments (32-C1.3)
C1
Femur, diaphyseal, complex segmental (32-C2)

2. With 1 intermediate segmental and
fracture (32-C2.1)
additional wedge fragments (32-C2.2)
(1) pure diaphyseal
(1) pure diaphyseal
(4) oblique lines
(4) distal wedge

fragments (32-C2.3)
(1) pure diaphyseal
C2
Femur, diaphyseal, complex irregular (32-C3)

1. With 2 or 3 intermediate fragments 2. With limited shattering (
5cm)
(32-C3.1)
(32-C3.2)
(1) proximal zone
(2) middle zone
(3) distal zone
5cm)
3. With extensive shattering (
(32-C3.3)
(1) pure diaphyseal
C3
S38
BONE: FEMUR (3)
Types:
Groups:
Femur, distal, extra-articular (33-A)
1. Simple
2. Meta(33-A1)
physeal
wedge
(33-A2)
Femur
3. Metaphyseal
complex
(33-A3)
B. Partial articular (33-B)
Femur, distal, partial articular (33-B)

2. Medial
3. Frontal
1. Lateral
condyle,
(33-B3)
condyle,
sagittal (33-B1) sagittal
(33-B2)
C. Complete articular (33-C)
Femur, distal, complete articular (33-C)

1. Articular
3. Multifrag2. Articular
simple, metamentary
simple, metaphyseal simple physeal multiarticular
(33-C1)
fracture
fragmentary
(33-C3)
(33-C2)
S39
Femur

Femur, distal, extra-articular simple (33-A1)
1. Apophyseal (33-A1.1)
2. Metaphyseal oblique or spiral
(1) avulsion lateral epicondyle
(33-A1.2)
(2) avulsion medial epicondyle
3. Metaphyseal transverse (33-A1.3)
A1
Femur, distal, extra-articular, metaphyseal wedge (33-A2)

1. Intact wedge (33-A2.1)
2. Fragmented lateral (33-A2.2)
(1) lateral
(2) medial
3. Fragmented medial (33-A2.3)
A2
Femur, distal, extra-articular, metaphyseal complex (33-A3)

1. With an intermediate split segment 2. Irregular limited to metaphysis
(33-A3.1)
(33-A3.2)
3. Irregular extending to diaphysis

(33-A3.3)
A3
S40
Femur, distal, partial articular, lateral condyle, sagittal (33-B1)

1. Simple through the notch (33-B1.1) 2. Simple through load bearing surface (33-B1.2)
Femur
B1
Femur, distal, partial articular, medial condyle, sagittal (33-B2)

1. Simple through notch (33-B2.1)
2. Simple through load bearing surface (33-B2.2)
B2
Femur, distal, partial articular, frontal (33-B3)

2. Unicondylar posterior (Hoffa)
1. Anterior and lateral flake fracture
(33-B3.2)
(33-B3.1)
(1) lateral
(2) medial
3. Bicondylar posterior (33-B3.3)
B3
S41
Femur
Femur, distal, complete articular, articular simple, metaphyseal simple (33-C1)

1. T- or Y-shaped with slight displace- 2. T- or Y-shaped with marked disment (33-C1.1)
placement (33-C1.2)
3. T-shaped epiphyseal (33-C1.3)
C1
Femur, distal, complete articular, articular simple, metaphyseal multifragmentary (33-C2)

1. With intact wedge (33-C2.1)
2. With fragmented wedge (33-C2.2)
(1) lateral
(1) lateral
(2) medial
(2) medial
C2
Femur, distal, complete articular, articular multifragmentary (33-C3)

(33-C3.2)
3. Metaphysio-diaphyseal multifragmentary (33-C3.3)
C3
S42
TIBIA/FIBULA
BONE: TIBIA/FIBULA (4)
Types:
Groups:
Tibia/fibula, proximal, extra-articular
1. Avulsion
2. Metaphy(41-A1)
seal simple
(41-A2)
(41-A)
3. Metaphyseal
multifragmentary (41-A3)
Tibia/fibula, proximal, partial articular (41-B)

2. Pure de1. Pure split
3. Split depression
(41-B1)
pression
(41-B2)
(41-B3)
Tibia/fibula, proximal, complete articular (41-C)

1. Articular
3. Articular
2. Articular
simple, metamultifragsimple, metaphyseal simple physeal multimentary
(41-C1)
(41-C3)
fragmentary
(41-C2)
S43
Tibia/Fibula

Tibia/fibula, proximal, extra-articular, avulsion (41-A1)
2. Of tibial tuberosity (41-A1.2)
1. Of fibular head (41-A1.1)
3. Of cruciate insertion (41-A1.3)

(1) anterior
(2) posterior
A1
Tibia/fibula, proximal, extra-articular, simple metaphysis (41-A2)

1. Oblique in frontal plane (41-A2.1)
2. Oblique in sagittal plane (41-A2.2)
A2
Tibia/fibula, proximal, extra-articular, multifragmentary metaphysis (41-A3)

2. Fragmented wedge (41-A3.2)
1. Intact wedge (41-A3.1)
(1) lateral
(1) lateral
(2) medial
(2) medial
(1) slightly displaced
(2) significantly displaced
A3
S44

Tibia/fibula, proximal, partial articular, split (41-B1)
1. Of lateral surface (41-B1.1)
2. Of medial surface (41-B1.2)
(1) marginal
(1) marginal
(2) sagittal
(2) sagittal
(3) frontal anterior
(3) frontal anterior
(4) frontal posterior
(4) frontal posterior
Tibia/Fibula
3. Oblique, involving the tibial spines

and 1 of the surfaces (41-B1.3)
(1) lateral
(2) medial
B1
Tibia/fibula, proximal, partial articular, depression (41-B2)

1. Lateral total (41-B2.1)
2. Lateral limited (41-B2.2)
(1) 1 piece
(1) peripheral
(2) mosaic-like
(2) central
(3) anterior
(4) posterior
3. Medial (41-B2.3)
(1) central
(2) anterior
(3) posterior
(4) total
B2
Tibia/fibula, proximal, partial articular, split depression (41-B3)

2. Medial (41-B3.2)
1. Lateral (41-B3.1)
(1) antero-lateral depression
(1) antero-lateral depression
(2) postero-lateral depression
(2) postero-lateral depression
(3) antero-medial depression
(3) antero-medial depression
(4) postero-medial depression
(4) postero-medial depression
3. Oblique involving the tibial spines

and 1 of the surfaces (41-B3.3)
(1) lateral
(2) medial
B3
S45
Tibia/Fibula
Tibia/fibula, proximal, complete articular, simple articular, simple metaphysis (41-C1)

(1) intact anterior tibial tubercle and intercondylar eminence
(2) anterior tibial tubercle involved
(3) intercondylar eminence involved
2. 1 condyle displaced (41-C1.2)
3. Both condyles displaced (41-C1.3)
1. Slight displacement (41-C1.1)
C1
Tibia/fibula, proximal, complete articular, articular simple, metaphysis multifragmentary (41-C2)

2. Fragmented wedge (41-C2.2)
1. Intact wedge (41-C2.1)
(1) lateral
(1) lateral
(2) medial
(2) medial
C2
Tibia/fibula, proximal, complete articular, articular multifragmentary (41-C3)

(1) metaphyseal simple
(2) metaphyseal lateral wedge
(3) metaphyseal medial wedge
(4) metaphyseal complex
(5) metaphysio-diaphyseal complex
1. Lateral (41-C3.1)
2. Medial (41-C3.2)
3. Lateral and medial (41-C3.3)
C3
S46
Tibia/Fibula
Types:
A. Simple (42-A)
B. Wedge (42-B)
Groups:
Tibia/fibula, diaphyseal, simple (42-A)
1. Spiral (42-A1) 2. Oblique
3. Transverse
30) (42-A2) (
(
30)
(42-A3)
Tibia/fibula, diaphyseal, wedge (42-B)

3. Frag(42-B1)
mented
wedge (42-B2)
wedge (42-B3)
C. Complex (42-C)
Tibia/fibula, diaphyseal, complex (42-C)

3. Irregular
1. Spiral
2. Segmented
(42-C3)
(42-C1)
(42-C2)
S47
Tibia/Fibula

Tibia/fibula, diaphyseal, simple, spiral (42-A1)
(1) proximal zone
(2) middle zone
(3) distal zone
1. Fibula intact (42-A1.1)
2. Fibula fracture at different level
(42-A1.2)
3. Fibula fracture at same level

(42-A1.3)
A1
Tibia/fibula, diaphyseal, simple, oblique (30) (42-A2)

(1) proximal zone
(2) middle zone
(3) distal zone
(42-A2.2)

(42-A2.3)
A2
Tibia/fibula, diaphyseal, simple, transverse (<30) (42-A3)

(1) proximal zone
(2) middle zone
(3) distal zone
(42-A3.2)

(42-A3.3)
A3
S48

Tibia/fibula, diaphyseal, wedge, spiral (42-B1)
(1) proximal zone
(2) middle zone
(3) distal zone
1. Fibula intact (42-B1.1)
(42-B1.2)
Tibia/Fibula

(42-B1.3)
B1
Tibia/fibula, diaphyseal, wedge, bending (42-B2)

(1) proximal zone
(2) middle zone
(3) distal zone
(42-B2.2)

(42-B2.3)
B2
Tibia/fibula, diaphyseal, wedge fragmented (42-B3)

(1) proximal zone
(2) middle zone
(3) distal zone
(42-B3.2)

(42-B3.3)
B3
S49
Tibia/Fibula
Tibia/fibula, diaphyseal, complex, spiral (42-C1)

(1) pure diaphyseal
(2) proximal diaphysio-metaphysis
(3) distal diaphysio-metaphysis
(42-C1.1)
(42-C1.2)

fragments (42-C1.3)
C1
Tibia/fibula, diaphyseal, complex segmental (42-C2)

2. With an intermediate segmental
1. With an intermediate segmental
and additional wedge fragment(s)
fragment (42-C2.1)
(42-C2.2)
(1) pure diaphyseal
(1) pure diaphyseal
(4) oblique lines
(4) distal wedge

fragments (42-C2.3)
(1) pure diaphyseal
C2
Tibia/fibula, diaphyseal, complex, irregular (42-C3)

1. With 2 or 3 intermediate fragments 2. Limited shattering (
4cm)
(42-C3.1)
(42-C3.2)
(1) 2 intermediate fragments
(2) 3 intermediate fragments
4cm)
3. Extensive shattering (
(42-C3.3)
(1) pure diaphyseal
C3
S50
Types:
Groups:
Tibia/fibula, distal, extra-articular (43-A)
1. Metaphyseal 2. Metaphy3. Metaphysimple (43-A1)
seal complex
seal wedge
(43-A3)
(43-A2)
Tibia/Fibula
Tibia/fibula, distal, partial articular (43-B)

1. Pure split
3. Multifragmen2. Split de(43-B1)
tary depression
pression
(43-B3)
(43-B2)
Tibia/fibula, distal, complete articular (43-C)

2. Articular
1. Articular
3. Articular
simple, metasimple, metamultifragmenphysis multiphysis simple
tary (43-C3)
fragmentary
(43-C1)
(43-C2)
S51
Tibia/Fibula

Tibia/fibula, distal, extra-articular, simple (43-A1)
(1) fibula intact
(2) simple fracture of fibula
(3) multifragmentary fracture of fibula
(4) bifocal fracture of fibula
1. Spiral (43-A1.1)
A1
Tibia/fibula, distal, extra-articular, wedge (43-A2)

(1) fibula intact
2. Anteromedial wedge (43-A2.2)
1. Posterolateral impaction (43-A2.1)
3. Extending into diaphysis (43-A2.3)
A2
Tibia/fibula, distal, extra-articular, complex (43-A3)

(1) fibula intact
2. More than 3 intermediate frag(43-A3.1)
ments (43-A3.2)
3. Extending into diaphysis (43-A3.3)
A3
S52
Tibia/fibula, distal, partial articular, pure split (43-B1)

(1) fibula intact
1. Frontal (43-B1.1)
2. Sagittal (43-B1.2)
(5) anterior
(5) lateral
(6) posterior (Volkmann)
(6) medial (medial malleolus)
Tibia/Fibula
(43-B1.3)
B1
Tibia/fibula, distal, partial articular, split depression (43-B2)

(1) fibula intact
(5) anterior
(5) lateral
(6) posterior
(6) medial
3. Of the central fragment (43-B2.3)
B2
Tibia/fibula, distal, partial articular, depression (43-B3)

(1) fibula intact
(5) anterior
(5) lateral
(6) posterior
(6) medial
3. Metaphyseal, multifragmentary
(43-B3.3)
B3
S53
Tibia/Fibula
Tibia/fibula, distal, complete articular, articular simple, metaphyseal simple (43-C1)

(1) fibula intact
1. Without impaction (43-C1.1)
2. With epiphyseal depression
(5) frontal plane
(43-C1.2)
(6) sagittal plane
C1
Tibia/fibula, distal, complete articular, articular simple, multifragmentary metaphysis (43-C2)

(1) fibula intact
2. Without asymmetric impaction
1. With asymmetric impaction
(43-C2.2)
(43-C2.1)
(5) frontal plane split
(6) sagittal plane split
C2
Tibia/fibula, distal, complete articular, articular multifragmentary (43-C3)

(1) fibula intact
2. Epiphysio-metaphyseal (43-C3.2)
1. Epiphyseal (43-C3.1)
3. Epiphysio-metaphysio-diaphyseal
(43-C3.3)
C3
S54
Types:
A. Infrasyndesmotic lesion (44-A)
Groups:
Tibia/fibula, malleolar, infrasyndesmotic lesions
(44-A)
3. With
2. With me1. Isolated
postero-medial
dial malleolar
(44-A1)
fracture
fracture
(44-A3)
(44-A2)
Tibia/Fibula
Location: Malleolar segment (44)
B. Transsyndesmotic fibula fracture (44-B)
Tibia/fibula, malleolar, transsyndesmotic fibula fracture (44-B)

2. With me1. Isolated
3. With medial lesion
(44-B1)
dial lesion
(44-B2)
and
Volkmann
(fracture of
the posterolateral rim)
(44-B3)
C. Suprasyndesmotic lesion (44-C)
Tibia/fibula, malleolar, suprasyndesmotic (44-C)

1. Simple dia2. Multifragphyseal fibular mentary fracfracture (44-C1) ture of fibular
diaphysis
(44-C2)
3. Proximal
fibula (44-C3)
S55
Tibia/Fibula

Tibia/fibula, malleolar, infrasyndesmotic, isolated (44-A1)
2. Avulsion of tip of lateral malleolus
1. Rupture of lateral collateral
(44-A1.2)
ligament (44-A1.1)
3. Transverse fracture of lateral malleolus (44-A1.3)
A1
Tibia/fibula, malleolar, infrasyndesmotic lesion with medial malleolar fracture (44-A2)

(1) transverse
(2) oblique
(3) vertical
3. Transverse fracture of lateral malleligament (44-A2.1)
(44-A2.2)
olus (44-A2.3)
A2
Tibia/fibula, malleolar, infrasyndesmotic lesion with postero-medial fracture (44-A3)

(44-A3.2)
ligament (44-A3.1)
3. Transverse fracture of lateral malleolus (44-A3.3)
A3
S56
Tibia/fibula, malleolar, transsyndesmotic, isolated (44-B1)

1. Simple (44-B1.1)
2. Simple with rupture of anterior
syndesmosis (44-B1.2)
(1) in substance
(2) Chaput (anterior tibia)
(3) Lefort (anterior fibula)
Tibia/Fibula
B1
Tibia/fibula, malleolar, transsyndesmotic fracture with medial lesion (44-B2)

1. Simple, rupture of medial collateral 2. Simple with fracture of medial
and anterior syndesmosis (44-B2.1)
malleolus and rupture of anterior syn(1) in substance
desmosis (44-B2.2)
(2) Chaput
(1) in substance
(3) Lefort
(2) Chaput
(3) Lefort
(1) rupture of medial collateral ligament
(2) fracture of medial malleolus
B2
Tibia/fibula, malleolar, transsyndesmotic with medial lesion and a Volkmann (fracture of posterolateral rim) (44-B3)
(1) extra-articular avulsion
(2) peripheral articular fragment
(3) significant articular fracture
1. Fibula simple with medial collateral 2. Simple fibula fracture with fracture
3. Multifragmentary with fracture of
ligament rupture (44-B3.1)
of medial malleolus (44-B3.2)
medial malleolus (44-B3.3)
B3
S57
Tibia/Fibula
Tibia/fibula, malleolar, susprasyndesmotic, simple diaphyseal fracture of fibula (44-C1)

2. With fracture of medial malleolus
1. Rupture of medial collateral
(44-C1.2)
and a Volkmann (Dupuytren)
ligament (44-C1.1)
(44-C1.3)
(3) significant articular fragment
C1
Tibia/fibula, malleolar, suprasyndesmotic, multifragmentary fibular diaphyseal fracture (44-C2)

1. With rupture of medial collateral
(44-C2.2)
and a Volkmann (Dupuytren)
ligament (44-C2.1)
(44-C2.3)
(3) significant articular fragment
C2
Tibia/fibula, malleolar, suprasyndesmotic, proximal fibular lesion (44-C3)

(1) fracture through neck
(2) fracture through head
(3) proximal tibiofibular dislocation
(4) rupture of medial collateral ligament
(5) fracture of medial malleolus
(6) articular fragment
1. Without shortening, without
2. With shortening, without
Volkmann (44-C3.1)
Volkmann (44-C3.2)
3. Medial lesion and a Volkmann

(44-C3.3)
C3
S58
PELVIS
BONE: PELVIS (6)
Location: Pelvic ring (61)
Types:
A. Lesion sparing (or with no displacement of)
posterior arch (61-A)
B. Incomplete disruption of posterior arch, partially stable (61-B)
The classification of pelvic ring and acetabular fractures is

based on the work of Pennal and Tile and Judet and Letournel.
This classification was developed to accommodate the alphanumeric system of The Comprehensive Long Bone System.
DEFINITIONS
Pelvic ring has two arches: (a) posterior arch is behind acetabular surface and includes sacrum, sacroiliac joints and
their ligaments and posterior ilium, and (b) anterior arch is in
front of acetabular surface and includes pubic rami bone and
symphyseal joint.
Anterior column of acetabulum extends from the anterior half
of the iliac crest to the pubis (iliopubic).
Posterior column of acetabulum extends from the greater sciatic notch to the ischium (ilioischial).
Unilateral: only 1 hemipelvis involved posteriorly.
Bilateral: both hemipelvis involved posteriorly.
Contralateral: the side opposite the major posterior lesion.
Ipsilateral: the side of the more severe lesion.
Stable: lesion sparing the posterior arch; pelvic floor intact
and able to withstand normal physiological stresses without
displacement.
C. Complete disruption of posterior arch, unstable (61-C)
Partially stable: posterior osteoligamentous integrity partially

maintained and pelvic floor intact.
Unstable: complete loss of posterior osteoligamentous integrity; pelvic floor disrupted.
Where appropriate, the Young-Burgess classification has
been added to the Subgroup and Qualification section.
Although these terms are not part of the alpha-numeric code,
they are added so that those using this classification can easily
code into the alpha-numeric system for documentation. The
following are the definitions of the Young-Burgess System:
APC: anterior-posterior compression; LC: lateral compression;
SI: sacroiliac; VS: vertical shear; CMI: combined mechanical instability.
ACKNOWLEDGEMENTS
The O.T.A. Coding and Classification Committee gratefully
acknowledges the following individuals for their significant
contributions to the development of systematic universal
pelvic and acetabular classifications:
Emile Letournel, MD; Marvin Tile, MD; Balz Isler, MD; David
Helfet, MD; Serge Nazarian, MD
S59
Pelvis
Groups:
Pelvis, ring, stable (61-A)
1. Fracture of innominate bone,
avulsion (61-A1)
2. Fracture of innominate bone, direct

blow (61-A2)
3. Transverse fracture of sacrum and

coccyx (61-A3)
2. Unilateral, partial disruption of

posterior arch, internal rotation (lateral compression injury) (61-B2)
3. Bilateral, partial lesion of posterior

arch (61-B3)
Pelvis, ring, partially stable (61-B)

1. Unilateral, partial disruption of
posterior arch, external rotation
(open-book injury) (61-B1)
Pelvis, ring, complete disruption of posterior arch unstable (61-C)

1. Unilateral, complete disruption of
2. Bilateral, ipsilateral complete, conposterior arch (61-C1)
tralateral incomplete (61-C2)
3. Bilateral, complete disruption

(61-C3)
S60

Pelvis, ring, stable, avulsion of innominate bone (61-A1)
2. Iliac crest (61-A1.2)
1. Iliac spine (61-A1.1)
(1) anterior superior
(2) anterior inferior
(3) pubic spine
Pelvis
3. Ischial tuberosity (61-A1.3)
A1
Pelvis, ring, stable, innominate bone, direct blow (61-A2)

2. Unilateral fracture of anterior arch
1. Iliac wing (61-A2.1)
(61-A2.2)
(1) 1 fragment
(1) through pubic bone/rami
(2) more than 1 fragment
(2) through pubic bone involving symphysis pubis
3. Bifocal fracture of anterior arch

(61-A2.3)
(1) bilateral pubic rami
(2) pubic rami on 1 side and symphysis
pubis
A2
Pelvis, ring, stable, transverse fracture of sacrum and coccyx (61-A3)

1. Sacrococcygeal dislocation (61-A3.1) 2. Sacrum undisplaced (61-A3.2)
3. Sacrum displaced (61-A3.3)
A3
S61
Pelvis
Pelvis, ring, partially stable, unilateral, external rotation (open book, APC-II) (61-B1)
(1) ipsilateral
(2) contralateral
(3) anterior lesion
1. Sacroiliac joint anterior disruption
2. Sacral fracture (61-B1.2, c*)
(61-B1.1)
B1
Pelvis, ring, partially stable, unilateral, internal rotation (lateral compression) (61-B2)
1. Anterior compression fracture of
2. Partial sacroiliac joint fracture/subsacrum (LC-I) (61-B2.1)
luxation (LC-II) (61-B2.2)
(1) anterior lesion ipsilateral
(2) anterior lesion contralateral
(2) anterior lesion contralateral (bucket
(bucket handle)
handle)
3. Incomplete posterior iliac fracture

(LC-II) (61-B2.3)
(2) anterior lesion contralateral (bucket
handle)
B2
Pelvis, ring, partially stable, bilateral (61-B3)

1. Bilateral B1 (open book, external
2. B1 and B2 (LC-III) (61-B3.2, a*, b**,
rotation) (APC-II) (61-B3.1)
c*)
(1) bilateral sacroiliac joint anterior
disruption
(2) bilateral sacral fracture
(3) unilateral partial SI joint disruption/
contralateral sacral fracture (c*)
3. Bilateral B2 (61-B3.3, a*, b**, c*)
B3
S62
Pelvis
Pelvis, ring, complete disruption, unilateral (APC-III) (61-C1)

2. Through sacroiliac joint (61-C1.2, c*) 3. Through the sacrum (61-C1.3, c*)
1. Through ilium (61-C1.1, c*)
(a1) lateral (ala)
(a1) transiliac fracture dislocation
(a2) pure dislocation
(a2) foraminal
3
(a ) transsacral fracture dislocation
(a3) medial to foramen
C1
Pelvis, ring, unstable, bilateral, ipsilateral complete, contralateral incomplete (LC-III) (61-C2)
2. Complete through sacroiliac joint
1. Complete through ilium
3. Complete through the sacrum
(61-C2.2, b*, c*)
(61-C2.1, b*, c*)
(61-C2.3, b*, c*)
(a1) transiliac fracture dislocation
(a1) lateral (ala)
(a2) pure dislocation
(a2) foraminal
(a3) transsacral fracture dislocation
(a3) medial to foramen
C2
Pelvis, ring, unstable, bilateral (APC-III) (61-C3, b***, c*)

1. Extrasacral on both sides (61-C3.1)
2. Sacral one side, extra sacral other
(a1) ilium; (a2) SI joint, transiliac fracture/ side (61-C3.2, b***, c*)
dislocation; (a3) SI joint, transsacral
(a1) sacral ala; (a2) sacral foraminal;
fracture/dislocation; (a4) SI joint
(a3) sacral medial to foramen
dislocation
3. Sacral both sides (61-C3.3, c*)

(a) a1) lateral alar; a2) foraminal; a3) medial
(b) b1) lateral alar; a2) foraminal; a3) medial
C3
Footnotes:
*a: Ipsilateral posterior pelvic lesion:
a1) sacroiliac joint anterior disruption; a2) sacral
fracture; a3) anterior compression fracture
sacrum; a4) partial sacroiliac joint fracture/subluxation; a5) incomplete posterior iliac fracture.
*b: Contralateral pelvic lesion:
b1) external rotation, open book partial disruption: .1) sacroiliac joint anterior disruption; .2)
sacral fracture
2
b ) internal rotation, lateral compression partial
disruption: .1) anterior compression fracture of
the sacrum; .2) partial sacroiliac joint

fracture/subluxation; .3) incomplete posterior
iliac fracture
**b: Contralateral posterior pelvic lesion:
bl) sacroiliac joint anterior disruption; b2) sacral
fracture; b3) anterior compression fracture
sacrum; b4) partial sacroiliac joint fracture/subluxation; b5) incomplete posterior iliac fracture.
***b: Contralateral pelvic lesion:
b1) ilium; b2) sacroiliac joint, transiliac fracture dislocation; b3) sacroiliac joint, transsacral fracture
dislocation; b4) sacroiliac joint, pure dislocation.
*c: Anterior pelvic lesion:

cl) unilateral pubis/rami fracture, ipsilateral: c2) unilateral pubis/rami fracture, contralateral; c3) bilateral pubis/rami fracture; c4) symphysis pubis
disruption, pure < 2.5 cm; c5) symphysis pubis
disruption, pure > 2.5 cm; c6) symphysis pubis
disruption, pure, locked; c7) symphysis and ipsilateral pubis/rami fracture (tilt); c8) symphysis
and contralateral pubis/rami fracture; c9) symphysis and bilateral pubis/rami fracture; c10) no anterior lesion.
S63
Pelvis
BONE: PELVIS (6)

Modifiers to describe articular surfaces:
1) femoral head subluxation, anterior; 2)
femoral head subluxation, medial; 3) femoral
head subluxation, posterior.
1) femoral head dislocation, anterior; 2)
femoral head dislocation, medial; 3) femoral
head dislocation, posterior.
1) acetabular surface, chondral lesion; 2) acetabular surface, impacted.
1) femoral head, chondral lesion; 2) femoral
head, impacted; 3) femoral head, osteochondral
fracture.
1) intraarticular fragment requiring surgical removal.
1) nondisplaced fracture of the acetabulum.
Types:
A. Partial articular, 1 column (62-A)
Groups:
Pelvis, acetabulum, partial articular, one column
(62-A)
1. Posterior wall 2. Posterior
3. Anterior
(62-A1)
(62-A3)
column
(62-A2)
S64
Location: Acetabulum (62)
B. Partial articular, transverse (62-B)
Pelvis, acetabulum, partial articular, transverse

(62-B)
2. T-shaped
1. Transverse
3. Anterior
(62-B2)
(62-B1)
column, posterior hemitransverse
(62-B3)
C. Complete articular, both

columns (62-C)
Pelvis, acetabulum, complete articular, both

columns (62-C)
1. High (62-C1) 2. Low
3. Involving
sacroiliac
(62-C2)
joint (62-C3)

Pelvis, acetabulum, partial articular, 1 column posterior wall (62-A1)
2. Pure fracture dislocation, multifrag1. Pure fracture dislocation, 1
mentary (62-A1.2, a*)
fragment (62-A1.1)
(1) posterior
(1) posterior
(2) posterior superior
(3) posterior inferior
Pelvis
3. Fracture dislocation with marginal

impaction (62-A1.3, a*)
(1) posterior
A1
Pelvis, acetabulum, partial articular, 1 column posterior column (62-A2)

2. Through obturator ring (62-A2.2)
1. Through ischium (62-A2.1)
(1) preserving tear drop
(2) involving tear drop
3. Associated with posterior wall

(62-A2.3, a*)
(1) pure fracture dislocation: .1) posterior; .2) posterior superior; .3) posterior
inferior
(2) with marginal impaction: .1) posterior; .2) posterior superior; .3) posterior
inferior
A2
Pelvis, acetabulum, partial articular, one column anterior (62-A3, a**)

1. Anterior wall (62-A3.1)
2. Anterior column, high (fracture to
iliac crest) (62-A3.2)
3. Low (fracture to anterior border)

iliac crest (62-A3.3)
A3
*a: a1) 1 fragment; a2) 2 fragments; a3) more than

2 fragments.
**a: a1) anterior column in 1 fragment; a2) anterior
column in 2 fragments; a3) anterior column in
more than 2 fragments.
S65
Pelvis
Pelvis, acetabulum, partial articular, transverse (62-B1)

2. Juxtatectal (62-B1.2, a*)
1. Infratectal (62-B1.1, a*)
3. Transtectal (62-B1.3, a*)
B1
Pelvis, acetabulum, partial articular, transverse T-type (62-B2)

2. Juxtatectal (62-B2.2, a*)
1. Infratectal (62-B2.1, a*)
(1) stem posterior
(1) stem posterior
(2) stem through obturator foramen
(3) stem anterior
(3) stem anterior
3. Transtectal (62-B2.3, a*)

(1) stem posterior
(3) stem anterior
B2
Pelvis, acetabulum, partial articular, transverse posterior hemitransverse, anterior column (62-B3)
3. Anterior column low (62-B3.3, a**)
2. Anterior column high (62-B3.2, a**)
1. Anterior wall (62-B3.1)
B3
*a: a1) pure transverse; a2) and posterior wall, single

fragments; a3) and posterior wall, multifragmentary; a4) and posterior wall, multifragmentary
with marginal impaction.
more than 2 fragments.
S66
Pelvis, acetabulum, complete, both columns high (62-C1)

2. Posterior column simple, anterior
1. Each column simple (62-C1.1)
column multifragmentary (62-C1.2)
Pelvis
3. Posterior column and posterior wall

(62-C1.3, a**, b*)
C1
Pelvis, acetabulum, complete articular, both columns low (62-C2)

2. Posterior column simple, anterior
1. Each column simple (62-C2.1)
column multifragmentary (62-C2.2)
3. Posterior column and posterior

wall (62-C2.3, a**, b*)
C2
Pelvis, acetabulum, complete articular, both columns involving sacroiliac joint (62-C3)
3. Posterior column multifragmen1. Anterior wall (62-C3.1)
2. Posterior column multifragmentary, anterior column low (62-C3.3,
(a1) anterior column simple, high
tary, anterior column high
a***, b**)
(a2) anterior column simple, low
(62-C3.2, a***, b**)
(a3) anterior column multifragmentary,
high
(a4) anterior column multifragmentary,
low
C3

more man 2 fragments.
***a: a1) anterior column simple; a2) anterior column multifragmentary.
*b: b1) posterior wall, single fragment; b2) posterior
wall, multifragmentary without impaction; b3)
posterior wall, multifragmentary with marginal
impaction.
**b: b1) pure separation; b2) and posterior wall, single fragment; b3) and posterior wall, multifragmentary without impaction; b4) and posterior
wall, multifragmentary with marginal impaction.
S67
SCAPULA
BONE: SCAPULA (14)
Types:
A. Extra-articular (not glenoid) (14-A)
Groups:
Scapula, extra-articular (not glenoid) (14-A)
3. Body
2. Coracoid
1. Acromion
(14-A3)
(14-A2)
(14-A1)
S68
B. Partial articular (glenoid) (14-B)
Scapula, partial articular (glenoid) (14-B)

1. Anterior rim 2. Posterior
3. Inferior rim
(14-B1)
rim (14-B2)
(14-B3)
C. Total articular (glenoid) (14-C)
Scapula, total articular (glenoid) (14-C)

1. Extra-articular 2. Intra-artic- 3. Intra-articglenoid neck
ular with neck ular with
(14-C1)
(14-C2)
body (14-C3)
J Orthop Trauma Volume 21, Number 10, November/December 2007
Scapula
Subgroups:
Scapula extra-articular (not glenoid) (14-A)
Acromion (14-A1)
2. Acromion, comminuted (14-A1.2)
1. Acromion, noncomminuted
(14-A1.1)
A1
Coracoid (14-A2)
1. Coracoid, noncomminuted (14-A2.1) 2. Coracoid, comminuted (14-A2.2)
A2
Body (14-A3)
1. Body, noncomminuted (14-A3.1)
2. Body, comminuted (14-A3.2)
A3
S69
Scapula
Subgoups:
Scapula extra-articular (glenoid) (14-B)
Anterior rim (14-B1)
1. Anterior rim, noncomminuted
(14-B1.1)
2. Anterior rim, comminuted (14-B1.2)
B1
Posterior rim (14-B2)

1. Posterior rim, noncomminuted
(14-B2.1)
2. Posterior rim, comminuted (14-B2.2)
B2
Inferior rim (14-B3)

1. Inferior rim, noncomminuted
(14-B3.1)
2. Inferior rim, comminuted (14-B3.2)
B3
S70
Subgoups:
Scapula extra-articular (glenoid) (14-C)
Extra-articular glenoid neck (14-C1)
1. Extra-articular glenoid neck,
noncomminuted (14-C1.1)
Scapula
2. Extra-articular glenoid neck, comminuted (14-C1.2)
C1
Intra-articular with neck (14-C2)

2. Intra-articular with neck, commin1. Intra-articular with neck, articular
noncomminuted, neck noncomminuted uted, articular noncomminuted
(14-C2.2)
(14-C2.1)
3. Intra-articular with glenoid neck,

articular comminuted (14-C2.3)
C2
Intra-articular with body (14-C3)
C3
S71
CLAVICLE
BONE: CLAVICLE (15)
Location: Medial end (15-A)
Location: Diaphysis (15-B)
Type:
A. Clavicle, medial end (15-A)
Type:
B. Clavicle, diaphysis (15-B)
Location: Lateral end (15-C)

Type:
C. Clavicle, lateral end (15-C)
Group:
Clavicle, medial end (15-A)
1. Extra-articular (15-A1)
Clavicle, diaphysis (15-B)

1. Simple (15-B1)
Clavicle, lateral end (15-C)

1. Extra-articular (15-C1)
2. Intra-articular (15-A2)
2. Wedge (15-B2)
2. Intra-articular (15-C2)
3. Comminuted (15-A3)
3. Complex (15-B3)
Note for clavicle:

There are no subgroups of A.
S72
BONE: CLAVICLE
Clavicle
Location: Diaphysis (15-B)
Groups:
Clavicle, diaphysis, noncomminuted (15-B1)
Subgroups:
1. Spiral (15-B1.1)
Clavicle, diaphysis, wedge (15-B2)

1. Spiral wedge (15-B2.1)
Clavicle, diaphysis, segmental (15-B3)

1. Spiral (15-B3.1)
2. Oblique (15-B1.2)
2. Bending wedge (15-B2.2)
2. 2 transverse (15-B3.2)
3. Transverse (15-B1.3)
3. Comminuted (15-B2.3)
3. Complex comminuted (15-B3.3)
S73
Clavicle
BONE: CLAVICLE
S74
Location: Lateral end (15-C)
Groups:
Clavicle, lateral end, extra-articular
(15-C1)
Clavicle, lateral end, intra-articular

(15-C2)
Subgroups:
1. Impacted (C-C ligament intact)
(15-C1.1)
1. With slight displacement (C-C ligament intact) (15-C2.1)
2. Noncomminuted (C-C ligament disrupted) (15-C1.2)
2. Noncomminuted (C-C ligament disrupted) (15-C2.2)
3. Comminuted (C-C ligament disrupted) (15-C1.3)
3. Comminuted (C-C ligament disrupted) (15-C2.3)
HAND AND CARPUS
AREA: HAND AND CARPUS (71-79)
Bones:
Lunate (71)
Scaphoid (72)
Capitate (73)
Hamate (74)
Ulnar carpal bones (75)
Radial carpal bones (76)
Metacarpals (77)
Phalanges (78)
Multiple hand and carpal fractures (79)

A. Carpal (79-A)
B. Metacarpal (79-B)
C. Phalanges (79-C)
S75
Hand and Carpus
Location: Carpus (71-76)

Types:
A. Noncomminuted
B. Comminuted
Lunate (71)
A. Noncomminuted (71-A)
B. Comminuted (71-B)
1. Proximal Pole (72-A1)
1. Proximal Pole (72-B1)
2. Waist (72-A2)
2. Waist (72-B2)
3. Distal pole (72-A3)
3. Distal Pole (72-B3)
Scaphoid (72)
Capitate (73)
S76
Hand and Carpus
Hamate (74)
1. Pisiform (75-A1)
2. Triquetrum (75-A2)
1. Pisiform (75-B1)
2. Triquetrum (75-B2)
1. Trapezium (76-A1)
2. Trapezoid (76-A2)
1. Trapezium (76-B1)
2. Trapezoid (76-B2)
Ulnar carpal bones (75)
Radial carpal bones (76)
S77
METACARPALS
BONE: METACARPALS (77)

Modifiers for metacarpals:
T, thumb; I, index; M, middle; R, ring; L, little.
Types:
A. Metacarpal proximal and distal
nonarticular and diaphysis noncomminuted (77-A)
Groups:
1. Metacarpal,
2. Metaproximal extra- carpal, diapharticular (77-A1) ysis noncomminuted
(77-A2)
S78
3. Metacarpal,
distal extraarticular
(77-A3)
Location: Metacarpals (77)
B. Metacarpal proximal and distal partial articular diaphysis

wedge comminution (77-B)
2. Metacarpal,
1. Metacarpal,
proximal partial diaphysis
articular (77-B1) wedge
(77-B2)
3. Metacarpal, distal
partial articular (77-B3)
C. Metacarpal proximal
and distal complete articular diaphysis comminuted
(77-C)
1. Metacarpal,
proximal
complete
articular
(77-C1)
2. Metacarpal, diaphysis comminuted

(77-C2)
3. Metacarpal, distal
complete
articular
(77-C3)
Metacarpals

Metacarpal, proximal extra-articular (77-A1)
2. Comminuted (77-A1.2)
1. Noncomminuted (77-A1.1)
(1) wedge
(2) complex
A1
Metacarpal, diaphysis noncomminuted (77-A2)

1. Spiral (77-A2.1)
A2
Metacarpal, distal extra-articular (77-A3)

A3
S79
Metacarpals
Metacarpal, proximal partial articular (77-B1)

2. Depression (77-B1.2)
1. Avulsion OR Split (77-B1.1)
(1) unicondyle medial
(2) unicondyle lateral
(3) coronal split volar fragment
(4) coronal split dorsal fragment
3. Split/depression (77-B1.3)
B1
Metacarpal, diaphysis wedge (77-B2)

1. Spiral (77-B2.1)
2. Bending (77-B2.2)
B2
Metacarpal, distal partial articular (77-B3)

B3
S80
Metacarpal, proximal articular (77-C1)

1. Noncomminuted articular and
metaphysis (77-C1.1)
2. Noncomminuted articular, comminuted metaphysis (77-C1.2)
Metacarpals
3. Comminuted articular (77-C1.3)
C1
Metacarpal, diaphysis comminuted (77-C2)

2. Complex comminuted (77-C2.2)
1. Segmental (77-C2.1)
C2
Metacarpal, distal articular (77-C3)

1. Simple articular/metaphysis
(77-C3.1)
2. Simple articular/comminuted metaphysis (77-C3.2)
C3
S81
PHALANX - HAND
Location: Phalanx (78)
BONE: PHALANX (78)

Modifiers for phalanx:
T1 and T2, thumb 1/2;
N1, N2 and N3, index
1/2/3; M1, M2 and M3,
middle 1/2/3; R1, R2
and R3, ring 1/2/3; L1,
L2 and L3, little 1/2/3.
Types:
A. Phalanx proximal and distal extra-articular and diaphysis noncomminuted
(78-A)
Groups:
1. Phalanx,
2. Phalanx diproximal extra- aphysis, nonarticular (78-A1) comminuted
(78-A2)
S82
3. Phalanx, distal extra-articular (78-A3)
B. Phalanx proximal and distal partial

articular and diaphysis wedge comminution (78-B)
2. Phalanx,
1. Phalanx,
(78-B2)
3. Phalanx,
distal partial
articular
(78-B3)
C. Phalanx proximal and distal

complete articular and diaphysis
comminuted (78-C)
1. Phalanx,
proximal
complete
articular (78-C1)
2. Phalanx,
diaphysis
comminuted
(78-C2)
3. Phalanx,
distal complete articular (78-C3)

Phalanx, proximal extra-articular (78-A1)
Phalanx - Hand
A1
Phalanx diaphyseal noncomminuted (78-A2)

1. Spiral (78-A2.1)
A2
Phalanx, distal extra-articular (78-A3)

1. Spiral noncomminuted (78-A3.1)
A3
S83
Phalanx - Hand
Phalanx, proximal partial articular (78-B1)

B1
Phalanx, diaphysis wedge (78-B2)

1. Spiral (78-B2.1)
3. Fragmented (78-B2.3)
B2
Phalanx, distal partial articular (78-B3)

B3
S84
Phalanx, proximal complete articular (78-C1)

2. Noncomminuted articular/commin1. Noncomminuted articular/
uted metaphysis (78-C1.2)
Phalanx - Hand
3. Comminuted articular and metaphysis (78-C1.3)
C1
Phalanx, diaphysis comminuted (78-C2)

C2
Phalanx, distal articular (78-C3)

1. Noncomminuted articular/metaphysis (78-C3.1)
2. Noncomminuted articular/comminuted metaphysis (78-C3.2)
C3
S85
PATELLA
BONE: PATELLA (34)
Types:
A. Patella extra-articular (34-A)
Groups:
Patella, extra-articular (34-A)
1. Patella, extra- 2. Patella,
extra-articuarticular,
avulsion (34-A1) lar isolated
body (34-A2)
Location: Patella (34)
B. Partial articular, vertical (34-B)
Patella, partial articular, vertical (34-B)

2. Patella, partial
1. Patella, partial
articular, vertical,
articular, vertical,
medial (34-B2)
lateral (34-B1)
C. Complete articular, non-vertical

(34-C)
Patella, complete
1. Patella,
articular,
transverse
(34-C1)
articular, non-vertical (34-C)

2. Patella, ar3. Patella, articular, transticular, comverse plus
minuted
second frag(34-C3)
ment (34-C2)
Note for patella:

There are no subgroups of A.
S86
Patella
Patella, partial articular, vertical, lateral (34-B1)

1. Noncomminuted (34-B1.1)
B1
Patella, partial articular, vertical, medial (34-B2)

B2
S87
Patella
Patella, complete articular, transverse (34-C1)

2. Proximal (34-C1.2)
1. Middle (34-C1.1)
3. Distal (34-C1.3)
C1
Patella, articular, transverse plus second fragment (34-C2)

2. Proximal (34-C2.2)
1. Middle (34-C2.1)
3. Distal (34-C2.3)
C2
Patella, articular, complex (34-C3)

1. With 3 fragments (34-C3.1)
2. More than 3 fragments (34-C3.2)
C3
S88
FOOT
AREA: FOOT (81-89)
Bones:
Talus (81)
Calcaneus (82)
Navicular (83)
Cuboid (84)
Cuneiforms (85)
Metatarsals (87)
Phalanges (88)
Crush, multiple foot fractures

(89)
A. Hind Foot (89-A)
B. Midfoot (89-B)
C. Forefoot (89-C)
Note for foot:

To stay as consistent with hand as possible, there are no bones coded for 86 allowing metacarpals and metatarsals and hand and foot phalanges each to be
coded with the same last digit.
S89
Foot
Location: Foot (81-85)
Types:
A. Avulsion or process or head fractures
(81-A)
Groups:
Talus avulsions process, or head fractures (81-A)
3. Head frac2. Process
1. Avulsions
tures (without
(81-A2)
(81-A1)
neck fracture)
(81-A3)
S90
BONE: TALUS (81)
B. Neck fractures (81-B)
Neck fractures (81-B)

1. Nondisplaced 2. Displaced
with subluxa(81-B1)
tion of subtalar joint
(81-B2)
C. Body fractures (81-C)
3. Displaced
with subluxation of subtalar and ankle
joints (81-B3)
Body fractures (81-C)

2. Subtalar
1. Ankle joint
joint involveinvolvment,
dome fractures ment
(81-C2)
(81-C1)
3. Ankle and
subtalar joint
involvement
(81-C3)

Groups:
Talus avulsions, process or head fractures (81-A)
1. Avulsions (81-A1)
1. Anterior (81-A1.1)
2. Process (81-A2)
1. Lateral (81-A2.1)
Foot
3. Head fractures (without neck fracture) (81-A3)

A
2. Other (81-A1.2)
Groups:
Neck fractures (81-B)
1. Nondisplaced (81-B1)
2. Posterior (81-A2.2)
2. Displaced with subluxation of subtalar joint

(81-B2)
3. Displaced with subluxation of subtalar and

ankle joints (81-B3)
3. Involves talar head (81-B2.3)
3. Involves talar head (81-B3.3)
Groups:
Body fractures (81-C)
1. Ankle joint involvement, dome fractures (81-C1) 2. Subtalar joint involvement (81-C2)
1. Noncomminuted (81-C2.1)
3. Ankle and subtalar joint involvement (81-C3)

2. Comminuted (81-C1.2)
S91
Foot
Location: Foot (81-85)
Types:
A. Avulsion or process or tuberosity (82-A)
S92
BONE: CALCANEUS (82)
B. Nonarticular body fractures (82-B)
C. Articular fractures involving posterior facet (82-C)
Foot
Groups:
Avulsion or process or tuberosity (82-A)
1. Anterior process (82-A1)
2. Medial, sustentaculum (82-A2)

3. Tuberosity (82-A3)
Groups:
Nonarticular body fractures (82-B)
1. Noncomminuted (82-B1)
2. Comminuted (82-B2)
Groups:
Articular fractures involving posterior
facet (82-C)
1. Nondisplaced (82-C1)
2. 2-part fractures (82-C2)
3. 3-part fractures (82-C3)
4. 4 or more parts (82-C4)
S93
Foot
BONE: NAVICULAR (83)

Types:
Types:
Types:
1. Medial (85-A1)
2. Middle (85-A2)
3. Lateral (85-A3)
1. Medial (85-B1)
2. Middle (85-B2)
3. Lateral (85-B3)
Types:
A. Hind Foot (89-A)
B. Midfoot (89-B)
BONE: CUBOID (84)
BONE: CUNEIFORM (85)
CRUSH, MULTIPLE FRACTURES (89)
S94
C. Forefoot (89-C)
METATARSALS
BONE: METATARSALS (87)

Modifiers for metatarsals:
T, thumb toe (great) (1); I, index toe (2); L, long toe
(3); R, ring toe (4); S, small toe (5).
Types:
1. Metatarsal proximal and distal
nonarticular and diaphysis noncomminuted (87-A)
Groups:
1. Metatarsal,
2. Metatarsal,
proximal extra- diaphysis
articular (87-A1) noncomminuted (87-A2)
3. Metatarsal,
distal extraarticular
(87-A3)
Location: Metatarsals (87)
2. Metatarsal proximal and distal partial articular diaphysis

wedge comminution (87-B)
2. Metatarsal,
1. Metatarsal,
(87-B2)
3. Metatarsal,
distal partial
articular
(87-B3)
3. Metatarsal proximal and

distal complete articular
diaphysis comminuted
(87-C)
1. Metatarsal,
proximal
complete
articular (87-C1)
2. Metatarsal,
diaphysis
comminuted
(87-C2)
3. Metatarsal,
S95
Metatarsals

Metatarsal, proximal extra-articular (87-A1)
(1) wedge
(2) complex
A1
Metatarsal, diaphysis noncomminuted (87-A2)

1. Spiral (87-A2.1)
A2
Metatarsal, distal extra-articular (87-A3)

A3
S96

Metatarsal, proximal partial articular (87-B1)
Metatarsals
B1
Metatarsal, diaphysis wedge (87-B2)

1. Spiral (87-B2.1)
3. Comminuted wedge (87-B2.3)
B2
Metatarsal, distal partial articular (87-B3)

B3
S97
Metatarsals
Metatarsal, proximal articular (87-C1)

1. Noncomminuted articular and
2. Noncomminuted articular, comminuted metaphysis (87-C1.2)
C1
Metatarsal, diaphysis Comminuted (87-C2)

C2
Metatarsal, distal articular (87-C3)

1. Simple articular/metaphysis
(87-C3.1)
2. Simple articular/comminuted metaphysis (87-C3.2)
C3
S98
PHALANX - FOOT
BONE: PHALANX (88)
Modifiers for phalanx:
T1 and T2, thumb toe
1/2; N1, N2 and N3,
index toe 1/2/3; M1,
M2 and M3, middle toe
1/2/3; R1, R2 and R3,
ring toe 1/2/3; L1, L2
and L3, little toe 1/2/3.
Location: Phalanx (88)
Types:
A. Phalanx proximal and distal extraarticular and diaphysis noncomminuted
(88-A)
Groups:
1. Phalanx,
2. Phalanx diproximal extra- aphysis, nonarticular (88-A1) comminuted
(88-A2)
3. Phalanx, distal extra-articular (88-A3)
B. Phalanx proximal and distal partial

articular and diaphysis wedge comminution (88-B)
2. Phalanx,
1. Phalanx,
(88-B2)
3. Phalanx,
distal partial
articular
(88-B3)
C. Phalanx proximal and distal

complete articular and diaphysis
comminuted (88-C)
1. Phalanx,
proximal
complete
articular (88-C1)
2. Phalanx,
diaphysis
comminuted
(88-C2)
3. Phalanx,
S99
Phalanx - Foot

Phalanx, proximal extra-articular (88-A1)
A1
Phalanx, diaphyseal noncomminuted (88-A2)

1. Spiral (88-A2.1)
A2
Phalanx, distal extra-articular (88-A3)

A3
S100
Phalanx, proximal partial articular (88-B1)

Phalanx - Foot
B1
Phalanx, diaphysis wedge (88-B2)

1. Spiral (88-B2.1)
3. Fragmented (88-B2.3)
B2
Phalanx, distal partial articular (88-B3)

B3
S101
Phalanx - Foot
Phalanx, proximal complete articular (88-C1)

2. Noncomminuted articular/commin1. Noncomminuted articular/
uted metaphysis (88-C1.2)
3. Comminuted articular and metaphysis (88-C1.3)
C1
Phalanx, diaphysis comminuted (88-C2)

C2
Phalanx, distal articular (88-C3)

1. Noncomminuted articular/metaphysis (88-C3.1)
2. Noncomminuted articular comminuted metaphysis (88-C3.2)
C3
S102
DISLOCATIONS
Practical suggestions for the application of the OTA dislocation classification system.
General principles.
Although there are many different ways in which dislocations can be classified, the OTA dislocation classification system is based primarily upon the basic tenets of identification of the exact joint involved and the direction of the distal bone relative to the proximal bone. These two basic principles of classification are applicable throughout the
skeletal system. The ligaments that are disrupted in each dislocation can be inferred from the classification but is not
a specific component of the classification process. Fracture-dislocations are generally assigned 2 separate codes, 1
for the fracture (bone) and 1 for the dislocation (joint). In general, the first digit of the numerical code represents the
body part and the second digit of the numerical code is 0 for dislocation. For example, 30 represents a hip dislocation with 3 indicating thigh and 0 dislocation of the hip (femoral-acetabular) joint. The third place (A,B,C,D and E)
is utilized when there are more than 2 bones in the anatomic region and hence more than 1 joint. Each specific 2
bone joint is assigned a third place designation (eg, knee joint 40-A is tibiofemoral and 40-B is patellofemoral). In
general, the dislocations are subclassified by the direction the distal bone is positioned relative to the proximal bone
at the time of dislocation. In most instances, the subtypes are 1, 2, 3, 4 and 5: 1 = anterior, 2 = posterior, 3 = lateral,
4 = medial, and 5 = other. For example, 40 refers to dislocations about the knee with 40-A1 being an anterior dislocation of the knee joint (with the tibia anterior to the femur). The designation of other is used for various situations including spontaneous reduction of a presumed dislocation where the direction is not known (eg, a knee injury
with disruption of the ACL and PCL but with the presentation radiographs demonstrating a reduced knee joint is 40A5). This other or 5 category is also used when direction of the dislocation does not meet the standard 4
anatomic directions (eg, 10-A5 for inferior dislocation of the shoulder or luxatio erecta). Some dislocations were
included in the long bone fracture classification (eg, forearm), and there is the potential for more than 1 code to be
appropriate for a given injury.
S103
Dislocations
DISLOCATION REGION: Shoulder (10)
Types by joint involved:
A. Glenohumeral (10-A)
S104
B. Acromioclavicular (10-B)
C. Sternoclavicular (10-C)
D. Scapulothoracic (10-D)
Dislocations
A. Glenohumeral (10-A)
Groups by direction:
2. Posterior (10-A2)
1. Anterior (10-A1)
3. Lateral (theoretical)
(10-A3)
4. Medial (theoretical)
(10-A4)
5. Other (inferior-luxatio erecta) (10-A5)
S105
Dislocations
B. Acromioclavicular (10-B)
1. Anterior (theoretical) (10-B1)
2. Posterior (10-B2)
3. Superior (10-B3)
4. Inferior (10-B4)
5. Other (10-B5)
Subgroups of 10-B3 by severity of displacement:

1. Grade 1 sprain (10-B3.1)
S106
2. Grade 2, partial displacement (10-B3.2)
3. Grade 3, 100% displacement (10-B3.3)
4. Grade 4, grade 3 plus

deltoid origin detached
from clavicle (10-B3.4)
Dislocations
C. Sternoclavicular (10-C)
1. Anterior (10-C1)
2. Posterior (10-C2)
3. Lateral (theoretical)
(10-C3)
4. Medial (theoretical)
(10-C4)
5. Other (10-C5)
D. Scapulothoracic (10-D)
S107
Dislocations
DISLOCATION REGION: Elbow (20):

A. Ulnohumeral with radiohumeral*
(20-A)
B. Isolated radiohumeral (20-B)
C. Distal radioulnar dislocation (20-C)
D. Other (20-D)
Notes for classification of elbow dislocations:

* For the purposes of elbow dislocation the radiohumeral joint is presumed to be dislocated as well as the ulnohumeral joint with
the radius going in the same direction as the ulna for types 20-A120-A4 and in different directions in 20-A5.
20-B is reserved for radiohumeral dislocations in which the ulnohumeral articulation is not dislocated.
Monteggia fracture dislocations should be coded as 20-B plus 22-A1, B1 or C1 (ulna shaft).
Galeazzi fracture dislocations should be coded as 20-C plus 22-A2, B2 or C2 (radial shaft)
20-C (distal radioulnar dislocations) used here rather than 70 to remain consistent with the lower extremity where 40-C and
40-D are used for proximal and distal tibiofibular dislocations.
Isolated proximal radioulnar dislocations (20-C) probably do not occur but 20-D could be used.
The long bone classification system also identifies alternative codes for some fracture dislocations in this anatomic region
and the codes 22-A3, 22-B3 and 22-C3 represent an alternative way to classify these injuries. With the 2007 version of the
classification system we generally recommend that fractures and dislocations be separately coded.
S108
Dislocations
A. Ulnohumeral (20-A)
1. Anterior (20-A1)
3. Medial (20-A3)
4. Lateral (20-A4)
5. Divergent (20-A5)
B. Radiohumeral (20-B)
1. Anterior (20-B1)
3. Medial (20-B3)
4. Lateral (20-B4)
S109
Dislocations
C. Distal radioulnar dislocations (20-C)
1. Anterior (volar) (20-C1)
S110
2. Posterior (dorsal) (20-C2)
3. Other (20-C3)
Dislocations
DISLOCATION REGION: Spine dislocation (50)

Types by area of spine:
A. Cervical (50-A)
B. Thoracic (50-B)
C. Lumbar (50-C)
Groups: Name the levels starting at Occiput-C1

Occiput-C1 dislocation (50-A1)
C1-C2 (50-A2)
C2-3 (50-A3)
C3-4 (50-A4)
C4-5 (50-A5)
C5-6 (50-A6)
C6-7 (50-A7)
C7-T1 dislocation (50-B1)

T1-2 (50-B2)
T2-3 (50-B3)
T3-4 (50-B4)
T4-5 (50-B5)
T5-6 (50-B6)
T6-7 (50-B7)
T7-8 (50-B8)
T8-9 (50-B9)
T9-10 (50-B10)
T10-11 (50-B11)
T11-12 (50-B12)
T12-L1 dislocation (50-C1)

L1-2 (50-C2)
L2-3 (50-C3)
L3-4 (50-C4)
L4-5 (50-C5)
L5-S1 dislocation (50-C6)
S111
Dislocations
DISLOCATION REGION: Hip (30):

Hip joint (30-A)
1. Anterior (30-A1)
3. Medial or central
(30-A3)
4. Obturator (30-A4)
5. Other (30-A5)
Notes for classification of hip dislocations:

A dislocation associated with an acetabular wall fracture should be coded with a fracture code (62) AND a dislocation code 30-A.
It is left to the discretion of the coder to decide what constitutes a 30-A3 which is necessarily associated with a displaced fracture of the central acetabulum. Although commonly referred to as a medial or central dislocation of the hip, the 30-A3 injury
is a particular pattern of fracture displacement rather than a true dislocation. It is left to the discretion of the coder to decide
when, if ever, to utilize 30-A3 in addition to the fracture code (62).
There are no current injury patterns appropriate for 30-B designation.
S112
Dislocations
DISLOCATION REGION: Knee (40)

A. Tibiofemoral (40-A)
B. Patellofemoral (40-B)
C. Tibiofibular (proximal)
(40-C)
D. Tibiofibular (distal)
(40-D)
Notes for classification of knee dislocations:

The classification committee recognizes that distal tibiofibular dislocations are NOT knee dislocations but they fit well here and
ARE dislocations associated with the leg bone segment 4. Distal tibiofibular dislocations (as well as DRUJ) could reasonably be
moved to 80 foot and ankle dislocations (and DRUJ to 70 wrist and hand dislocations). However, those segments already have
many codes because there are so many joints in these body parts with small bones. Therefore for practical and consistency
reasons distal tibiofibular dislocations are assigned to the 40 section.
Knee dislocations in which the direction is unknown, for example bicruciate ligament tears, should be coded as 40-A5 (other)
Quadriceps and patellar tendon tears can be coded as patellofemoral dislocations 40-B1 and 40-B2.
The patella is considered the more distal bone for 40-B.
The fibula is considered the more distal bone for tibiofibular dislocations.
S113
Dislocations
A. Tibiofemoral (40-A)
1. Anterior (40-A1)
S114
3. Medial (40-A3)
4. Lateral (40-A4)
5. Other (40-A5)
Dislocations
B. Patellofemoral (40-B)
Groups by direction of the patella:

1. Distal (quadriceps tendon disruption) (40-B1)
3. Medial patellofemoral dislocation

(40-B3)
2. Proximal (patellar tendon disruption) (40-B2)
4. Lateral patellofemoral dislocation

(40-B4)
5. Other (40-B5)
S115
Dislocations
C. Proximal tibiofibular dislocation

(40-C)
1. Anterior (40-C1)
2. Posterior (40-C2)
3. Lateral (40-C3)
4. Medial (40-C4)
5. Other (40-C5)
Subgroups of 40-C5:
1. Superior (40-C5.1)
S116
2. Inferior (40-C5.2)
Dislocations
D. Distal tibiofibular dislocation

(40-D)
Groups by the direction of the fibula:

1. Anterior (40-D1)
2. Posterior (40-D2)
3. Lateral (40-D3)
4. Other (40-D5)
Subgroups of 40-D5:
1. Superior (40-D5.1)
2. Inferior (40-D5.2)
S117
Dislocations
DISLOCATION REGION: Pelvic dislocation (60)

A. Sacroiliac right (60-A)
B. Sacroiliac left (60-B)
C. Symphysis pubis (60-C)
A. Sacroiliac right (60-A)
1. Anterior (60-A1)
3. Lateral (60-A3)
4. Other (eg proximal)

(60-A4)
Notes for classification of pelvic dislocations:

Because pubic diastasis and sacroiliac (SI) joint dislocations and fracture dislocations are such an integral component of pelvic
ring disruption, pelvic fracture codes (61), the 60 codes are restricted to pure dislocations without fracture. 61 codes are
to be used for fracture dislocations or pelvic ring injuries that include fractures AND SI or symphysis disruptions. Therefore the
following:
60 codes are for pure dislocations. Pelvic ring disruptions with fractures (with or without SI and symphysis joint injuries) should
be classified by the 61 codes.
Each joint should be coded separately. Thus a single patient with pure dislocations (no fractures) of both SI joints and the
pubic symphysis would be coded 60-B2 (left SI posterior dislocation), 60-A1 (right SI dislocation with ilium anteriorly displaced) and 60-C3 (pubic symphysis dislocation with the right side displaced proximal to the left).
S118
Dislocations
B. Sacroiliac left (60-B)

1. Anterior (60-B1)
3. Lateral (60-B3)
4. Other (eg proximal)

(60-B4)
C. Symphysis pubis (60-C)

1. Right side anterior (60-C1)
2. Right side posterior (60-C2)
4. Right side distal (60-C4)
5. Open or wide (60-C5)
3. Right side proximal (60-C3)
S119
Dislocations
DISLOCATION REGION: Hand and Wrist (70)
Types by area or joints involved:

A. Radiocarpal
(70-A)
B. Intercarpal
(70-B)
C. Carpal-metacarpal
(70-C)
D. Phalanx (70-D)
Carpal bones
Notes for classification of wrist and hand dislocations:

Distal radioulnar dislocations are classified under section 20-D.
The classification is designed to be as consistent as possible between hand and foot.
The designation of 9 in the fourth digit is available to code multiple injuries to the small bones and joints of the foot, hand
and wrist and are available to coders desiring a more general level of specificity. If more specific designation is desired, then
individual codes can be applied to each specific dislocation.
There are no subgroups of 70-B.
If there is associated fracture, use fracture code in addition to dislocation code.
S120
Dislocations
A. Radiocarpal (wrist joint) (70-A)
Groups by direction of the distal fragment:

1. Anterior (volar)
(70-A1)
2. Posterior (dorsal)
(70-A2)
3. Radial (70-A3)
4. Ulnar (70-A4)
5. Other (70-A5)
B. Intercarpal dislocations (70-B)
S121
Dislocations
C. Carpal-metacarpal joints (70-C)
Groups by joint involved radial to ulnar:
1. 1st metacarpal-trapezial dislocation (70-C1)
2. 2nd metacarpal-trapezium dislocation (70-C2)
3. 3rd metacarpal capitate dislocation (70-C3)
4. 4th metacarpal hamate dislocation (70-C4)
5. 5th metacarpal triquetrum dislocation (70-C5)
6. Multiple carpal-metacarpal dislocations (70-C9)
S122
Dislocations
D. Phalangeal dislocations (70-D)
Groups by level involved:

1. Metacarpal phalangeal
(70-D1)
2. Proximal interphalangeal
(70-D2)
4. Sesamoid dislocation (70-D4)
5. Multiple finger dislocations (70-D9)
3. Distal interphalangeal
(70-D3)
S123
Dislocations
1. Metacarpal phalangeal joint (70-D1)

Subgroups by joint involved radial to ulnar:
1. 1st metacarpal
phalangeal joint
(70-D1.1)
2. 2nd metacarpal
phalangeal joint
(70-D1.2)
3. 3rd metacarpal
phalangeal joint
(70-D1.3)
4. 4th metacarpal
phalangeal joint
(70-D1.4)
5. 5th metacarpal
phalangeal joint
(70-D1.5)
4. Ring (4th)
(70-D2.4)
5. Small (5th)
(70-D2.5)
4. Ring (4th)
(70-D3.4)
5. Small (5th)
(70-D3.5)
2. Proximal interphalangeal joint (70-D2)

1. Thumb (1st)
(70-D2.1)
2. Index (2nd)
(70-D2.2)
3. Long (3rd)
(70-D2.3)
3. Distal interphalangeal joint (70-D3)

1. None
S124
2. Index (2nd)
(70-D3.2)
3. Long (3rd)
(70-D3.3)
Dislocations
DISLOCATION REGION: Foot and Ankle (80)
Types by area or joint involved:

A. Ankle (talotibial) (80-A)
B. Hindfoot (subtalar) (80-B)
C. Midfoot (80-C)
D. Forefoot (80-D)
A. Ankle (80-A)
1. Anterior (80-A1)
3. Medial (80-A3)
4. Lateral (80-A4)
5. Other (80-A5)
Notes for classification of foot and ankle dislocations:

Distal tibiofibula dislocations are classified under section 40-D.
Talar neck fracture classification is intimately related to associated dislocations and therefore are included in the fracture codes
for talus (81).
S125
Dislocations
B. Subtalar (80-B)
1. Anterior (80-B1)
3. Medial (80-B3)
4. Lateral (80-B4)
5. Other (80-B5)
C. Midfoot (80-C)
Groups by joint involved:

1. Talonavicular (80-C1)
2. Calcaneocuboid (80-C2)
3. Navicular-cuneiform dislocation
(80-C3)
4. Intercuneiform dislocation (80-C4)
5. Tarsal-metatarsal dislocation (80-C5)
6. Multiple midfoot dislocations

(80-C9)
S126
Dislocations
Tarsal-metatarsal dislocation (80-C5)

Subgroups by joint involved medial to lateral:
1st metatarsal medial cuneiform dislocation (80-C5.1)
2nd metatarsal second cuneiform dislocation (80-C5.2)
3rd metatarsal lateral cuneiform dislocation (80-C5.3)
4th metatarsal cuboid dislocation (80-C5.4)
5th metatarsal cuboid dislocation (80-C5.5)
6. multiple metatarsal-tarsal dislocations (80-C5.9)
Note. Subclassification by direction is not given specific codes.
D. Forefoot (80-D)
S127
Dislocations
Groups by level involved:

1. Metatarsal-phalangeal (80-D1)
2. Proximal interphalangeal (80-D2)
4. Sesamoid dislocation (any) (80-D4)
3. Distal interphalangeal (80-D3)
5. Multiple forefoot dislocations (80-D9)
1. Metatarsal-phalangeal joint (80-D1)

Subgroups by joint medial to lateral:
1.
2.
3.
4.
5.
1st metatarsal phalangeal joint (80-D1.1)

2nd metatarsal phalangeal joint (80-D1.2)
3rd metatarsal phalangeal joint (80-D1.3)
4th metatarsal phalangeal joint (80-D1.4)
5th metatarsal phalangeal joint (80-D1.5)
2. Proximal interpahalangeal joint (80-D2)

1. 1st toe (IP joint as there is no PIP in big toe)
(80-D2.1)
2. 2nd toe (80-D2.2)
3. 3rd toe (80-D2.3)
4. 4th toe (80-D2.4)
5. 5th toe (80-D2.5)
3. Distal interphalangeal joint (80-D3)

1.
2.
3.
4.
5.
No code as there is no DIP in big toe

2nd toe (80-D3.2)
3rd toe (80-D3.3)
4th toe (80-D3.4)
5th toe (80-D3.5)
S128
SPINE
BONE: SPINE (5)
Location: Cervical (51)
Types:
A. Compression injuries of the body
(compressive forces) (5_-A)
Location: Thoracic (52)
B. Distraction injuries of the anterior

and posterior elements (tensile forces)
(5_-B)
Location: Lumbar (53)
C. Multidirectional injuries
with translation affecting the
anterior and posterior elements (axial torque causing
rotation injuries) (5_-C)
S129
Spine
BONE: SPINE (5)
Groups:
Vertebral body compression type (5_-A)
1. Impaction fractures (5_-A1)

Vertebral body compression fractures, impaction
injury (5_-A1)
1. End plate impaction (5_-A1.1)
2. Wedge impaction (5_-A1.2)
3. Vertebral body collapse (5_-A1.3)
S130
Types:
A. Compression injuries of the body
(compressive forces) (5_-A)
2. Split fractures (5_-A2)
3. Burst fractures (5_-A3)
Vertebral body compression fractures, split (5_-A2)
Vertebral body compression burst fractures (5_-A3)
1. Sagittal (5_-A2.1)
2. Coronal (5_-A2.2)
3. Pincer (5_-A2.3)
1. Incomplete burst (5_-A3.1)

2. Burst-split (5_-A3.2)
3. Complete burst (5_-A3.3)

BONE: SPINE (5)
B. Distraction injuries of the anterior

and posterior elements (tensile forces)
(5_-B)
Groups:
Anterior or posterior element injury with distraction (5_-B)
1. Posterior disruption
predominantly
ligamentous (flexiondistraction injury) (5_-Bl)

Posterior disruption ligamentous (5_-B1)
1. With transverse disruption of the disc (5_-B1.1)
2. Vertebral body compression fracture (5_-B1.2)
Spine
2. Posterior disruption predominantly osseous (flexiondistraction injury) (5_-B2)
Posterior disruption osseous (5_-B2)

1. Transverse bicolumn fracture (5_-B2.1)
2. With transverse disruption of the disc
(5_-B2.2)
3. With vertebral body compression (5_-B2.3)
3. Anterior disruption
through the disc (hyperextension-shear injury) (5_-B3)
Anterior disruption through the disc (5_-B3)

1. Hyperextension-subluxation (5_-B3.1)
2. Hyperextension-spondylolysis (5_-B3.2)
3. Posterior dislocation (5_-B3.3)
S131
Spine
BONE: SPINE (5)
C. Multidirectional injuries
with translation affecting the
anterior and posterior elements (axial torque causing
rotation injuries) (5_-C)
Groups:
Anterior or posterior element injury with rotation (5_-C)
1. Rotational wedge, split,
and burst fractures (5_-C1)

Rotational wedge, split and burst fractures (5_-C1)
1. Rotational wedge fractures (5_-C1.1)
2. Rotational split fractures (5_-C1.2)
3. Rotational burst fractures (5_-C1.3)
S132
2. Flexion subluxation with

rotation (5_-C2)
Flexion subluxation with rotation (5_-C2)

1. Flexion-distraction injuries with rotation
(5_-C2.1)
2. B2 with rotation (5_-C2.2)
3. Hyperextension-shear-rotation of spine
(5_-C2.3)
3. Rotational shear injuries

(Holdsworth slice rotation
fracture) (5_-C3)
Rotational shear injuries (5_-C3)

1. Slice (5_-C3.1)
2. Oblique (5_-C3.2)
REFERENCES
1. Fracture and dislocation compendium. Orthopaedic Trauma Association
Committee for Coding and Classification. J Orthop Trauma. 1996:10
(Suppl 1):v-ix, 1154.
2. Mller ME, Nazarian S, Koch P, et al. The Comprehensive Classification
of Fractures of Long Bones. Berlin, Germany: Springer-Verlag;1990.
3. Websters New Riverside University Dictionary. Boston, MA: Riverside
Publishing; 1984:268.
4. Martin JS, Marsh JL. Current classification of fractures. Rationale and
utility. Radiol Clin North Am. 1997;35:491506.
5. Brumback RJ, Jones AL. Interobserver agreement in the classification
of open fractures of the tibia. The results of a survey of two hundred and
forty-five orthopaedic surgeons. J Bone Joint Surg Am. 1994;76:
11621166.
6. Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The
Toronto experience 19681975. Clin Orthop Relat Res. 1979;138:
94104.
7. Siebenrock KA. Gerber C. The reproducibility of classification of fractures of the proximal end of the humerus. J Bone Joint Surg Am.
1993;75:17511755.
8. Martin JS, Marsh JL, Bonar SK, et al. Assessment of the AO/ASIF
fracture classification for the distal tibia. J Orthop Trauma. 1997;11:
477483.
9. Sidor ML, Zuckerman JD, Lyon T, et al. The Neer classification system
for proximal humeral fractures. An assessment of interobserver reliability and intraobserver reproducibility. J Bone Joint Surg Am. 1993;75:
17451750.
10. Petrisor BA, Bhandari M, Orr RD, et al. Improving reliability in the
classification of fractures of the acetabulum. Arch Orthop Trauma Surg.
2003;123:228233.
11. Kristiansen B, Andersen UL, Olsen CA, et al. The Neer classification of
fractures of the proximal humerus. An assessment of interobserver variation. Skeletal Radiol. 1988;17:420422.
12. Bernstein J, Adler LM, Blank JE, et al. Evaluation of the Neer system
of classification of proximal humeral fractures with computerized tomographic scans and plain radiographs. J Bone Joint Surg Am. 1996;78:
13711375.
13. Flikkil T, Nikkola-Sihto A, Kaarela O, et al. Poor interobserver reliability of AO classification of fractures of the distal radius. Additional
computed tomography is of minor value. J Bone Joint Surg Br. 1998;80:
670672.
14. Humphrey CA, Dirschl DR, Ellis TJ. Interobserver reliability of a CTbased fracture classification system. J Orthop Trauma. 2005;19:616622.
15. Barker L, Anderson J, Chesnut R, et al. Reliability and reproducibility of
dens fracture classification with use of plain radiography and reformatted
computer-aided tomography. J Bone Joint Surg Am. 2006;88: 106112.
16. Dirschl DR, Adams GL. A critical assessment of factors influencing reliability in the classification of fractures, using fractures of the tibial plafond as a model. J Orthop Trauma. 1997;11:471476.
17. Parsons BO, Klepps SJ, Miller S, et al. Reliability and reproducibility of
radiographs of greater tuberosity displacement. A cadaveric study. J Bone
Joint Surg Am. 2005;87:5865.
18. Schipper IB, Steyerberg EW, Castelein RM, et al. Reliability of the
AO/ASIF classification for pertrochanteric femoral fractures. Acta Orthop
Scand. 2001;72:3641.
19. Walton NP, Harish S, Roberts C, et al. AO or Schatzker? How reliable

is classification of tibial plateau fractures? Arch Orthop Trauma Surg.
2003;123:396398.
20. Andersen DJ, Blair WF, Steyers CM, et al. Classification of distal radius
fractures: an analysis of interobserver reliability and intraobserver reproducibility. J Hand Surg [Am]. 1996:21:574582.
21. Swiontkowski MF, Sands AK, Agel J, et al. Interobserver variation in
the AO/OTA fracture classification system for pilon fractures: is there a
problem? J Orthop Trauma. 1997;11:467470.
22. Kreder HJ, Hanel DP, McKee M, et al. Consistency of AO fracture classification for the distal radius. J Bone Joint Surg Br. 1996;78:726731.
23. Craig WL 3rd, Dirschl DR. Effects of binary decision making on the
classification of fractures of the ankle. J Orthop Trauma. 1998;12:
280283.
24. Kreder HJ, Hanel DP, McKee M, et al. Radiographic fracture assessments: which ones can we reliably make? J Orthop Trauma. 2000;14:
379385.
25. Follmann D, Wittes J, Cutler JA. The use of subjective rankings in clinical trials with an application to cardiovascular disease. Stat Med.
1992;11:427437; discussion 439454.
26. Oskam J, Kingma J, Klasen HJ. Interrater reliability for the basic categories of the AO/ASIFs system as a frame of reference for classifying
distal radial fractures. Percept Mot Skills. 2001;92:589594.
27. Williams TM, Nepola JV, DeCoster TA, et al. Factors affecting outcome
in tibial plafond fractures. Clin Orthop Relat Res. 2004;423:9398.
28. DeCoster TA, Willis MC, Marsh JL, et al. Rank order analysis of tibial
plafond fractures: does injury or reduction predict outcome? Foot Ankle
Int. 1999;20:4449.
29. Audig L, Bhandari M, Kellam J. How reliable are reliability studies of
fracture classifications? A systematic review of their methodologies.
Acta Orthop Scand. 2004;75:184194.
30. Kreder HJ, Hanel DP, McKee M, et al. X-ray film measurements for
healed distal radius fractures. J Hand Surg [Am]. 1996;21:3139.
31. Buckwalter JA, Schumacher R, Albright JP, et al. The validity of orthopaedic in-training examination scores. J Bone Joint Surg Am. 1981;
63:10011006.
32. Barei DP, Nork SE, Mills WJ, et al. Functional outcomes of severe bicondylar tibial plateau fractures treated with dual incisions and medial
and lateral plates. J Bone Joint Surg Am. 2006;88:171321.
33. Audig L, Bhandari M, Hanson B, et al. A concept for the validation of
fracture classifications. J Orthop Trauma. 2005;19:401406.
34. Slongo T, Audig L, Schlickewei W, et al. 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. J Pediatr Orthop. 2006;26:4349.
35. Audig L, Hunter J, Weinberg AM, et al. Development and evaluation
process of a pediatric long-bone fracture classification proposal. Eur J
Trauma. 2004;30:248254.
36. Slongo T, Audig L, Clavert JM, et al. The AO comprehensive classification of pediatric long-bone fractures: a web-based multicenter agreement study. J Pediatr Orthop. 2007;27:171180
37. Slongo T, Audig L, Lutz N, et al. Documentation of fracture severity
with the AO classification of pediatric long-bone fractures. Acta Orthop.
2007;78:247253.
S133

Clasificacion OTA Completa

Transféré par

Informations du document

Copyright

Formats disponibles

Partager ce document

Partager ou intégrer le document

Options de partage

Avez-vous trouvé ce document utile ?

Ce contenu est-il inapproprié ?

Droits d'auteur :

Formats disponibles

Clasificacion OTA Completa

Transféré par

Droits d'auteur :

Formats disponibles

INTRODUCTION

Fracture and Dislocation Classification

THE RATIONALE FOR REPUBLISHING

J Orthop Trauma Volume 21, Number 10 Supplement, November/December 2007

Journal of Orthopaedic Trauma Volume 21, Number 10 Supplement, November/December 2007

The purpose of this new classification compendium is to

Journal of Orthopaedic Trauma Volume 21, Number 10 Supplement, November/December 2007

ual investigators to suit their own purposes and were widely

FRACTURE CLASSIFICATION: ISSUES WITH

classification. The language and assumptions we use to group

Journal of Orthopaedic Trauma Volume 21, Number 10 Supplement, November/December 2007

NEW INITIATIVES IN CLASSIFICATION

lent substitute for classification. As problems with categorical

Journal of Orthopaedic Trauma Volume 21, Number 10 Supplement, November/December 2007

A Mller-AO classification system

B OTA classification system

FIGURE 1. Designation of bone location

classification modules. Drawing fracture lines or clicking

THE PROCESS OF REVISING THE COMPENDIUM

included in the original Comprehensive Classification proposed

Journal of Orthopaedic Trauma Volume 21, Number 10 Supplement, November/December 2007

and OTA numbering schemes and the new unified numbering

in the second digit. Dislocations will be coded separately

Introductory Message from the AO Classification Supervisory Committee

methodology. The OTA and the AO Classification Supervisory

2007 Lippincott Williams & Wilkins

Location: Proximal segment (11)

BONE: HUMERUS (1)

B. Extra-articular, bifocal fracture (11-B)

Humerus, proximal segment, extra-articular bifocal

C. Articular fractures (11-C)

Humerus, proximal segment, articular fractures

2007 Lippincott Williams & Wilkins

J Orthop Trauma Volume 21, Number 10 Supplement, November/December 2007

Subgroups and Qualifications:

3. With glenohumeral dislocation

Humerus, proximal, extra-articular, unifocal, impacted metaphyseal (11-A2)

3. With valgus malalignment

Humerus, proximal, extra-articular, unifocal, non-impacted metaphyseal (11-A3)

2007 Lippincott Williams & Wilkins

J Orthop Trauma Volume 21, Number 10 Supplement, November/December 2007

3. Posterior plus greater tuberosity

Humerus, proximal, extra-articular, bifocal, without metaphyseal impaction (11-B2)

3. Multifragmentary metaphysis plus

Humerus, proximal, extra-articular, bifocal

with glenohumeral dislocation (11-B3)

3. Lesser tuberosity fracture plus posterior dislocation (11-B3.3)

2007 Lippincott Williams & Wilkins

J Orthop Trauma Volume 21, Number 10 Supplement, November/December 2007

Humerus, proximal, articular fracture with slight displacement (11-C1)

3. Anatomical neck (11-C1.3)

Humerus, proximal, articular fracture impacted with marked displacement (11-C2)

3. Transcephalic (double profile image

Humerus, proximal, articular fracture dislocated (11-C3)

2007 Lippincott Williams & Wilkins

J Orthop Trauma Volume 21, Number 10 Supplement, November/December 2007

Location: Diaphyseal segment (12)

BONE: HUMERUS (1)

2007 Lippincott Williams & Wilkins

B. Wedge fracture (12-B)

Humerus diaphyseal, wedge (12-B)

C. Complex fracture (12-C)

Humerus diaphyseal, complex (12-C)

J Orthop Trauma Volume 21, Number 10 Supplement, November/December 2007