Distal Radius Fracture - Classification

Classification

In medicine, classifications systems are devised to describe patterns of injury which will behave in predictable ways, to distinguish between conditions which have different outcomes or which need different treatments. Most wrist fracture systems have failed to accomplish any of these goals and there is no consensus about the most useful one.

At one extreme, a stable undisplaced extra-articular fracture has an excellent prognosis. On the other hand, an unstable, displaced intra-articular fracture is difficult to treat and has a poor prognosis without operative intervention.

Eponyms such as Colles', Smith's, and Barton's fractures are discouraged. Though the Frykman classification system has traditionally been used, there is little value in its use because it does not help direct treatment. The Universal classification system is descriptive but also does not direct treatment. Universal codes include:

• • Type I: extra articular, undisplaced
  • Type II: extra articular, displaced
  • Type III intra articular, undisplaced
  • Type IV: intra articular, displaced

The system that comes closest to directing treatment has been devised by Melone:

• • I Stable fracture
  • II Unstable "die-punch"
  • III "Spike" fracture
  • IV Split fracture
  • V Explosion injuries

However, an anatomic description of the fracture is the easiest way to describe the fracture, decide on treatment, and make an assessment of stability.

• • Articular incongruity
  • Radial shortening
  • Radial angulation
  • Comminution of the fracture (the amount of crumbling at the fracture site
  • Open (compound fracture) or closed injury
  • Associated ulnar styloid fracture
  • Associated soft tissue injuries