TIBIA/FIBULA BONE: TIBIA/FIBULA (4) Location: Proximal segment (41) Types: A. Extra-articular (41-A) B. Partial articular (41-B) C. Complete articular (41-C) Groups: Tibia/fibula, proximal, extra-articular (41-A) Tibia/fibula, proximal, partial articular (41-B) Tibia/fibula, proximal, complete articular (41-C) 1. Avulsion 2. Metaphy- 3. Metaphyseal 1. Pure split 2. Pure de- 3. Split de- 1. Articular 2. Articular 3. Articular (41-A1) seal simple multifragmen- (41-B1) pression pression simple, meta- simple, meta- multifrag- (41-A2) tary (41-A3) (41-B2) (41-B3) physeal simple physeal multi- mentary (41-C1) fragmentary (41-C3) (41-C2) © 2007 Lippincott Williams & Wilkins S43 Tibia/Fibula J Orthop Trauma • Volume 21, Number 10 Supplement, November/December 2007 Subgroups and Qualifications: Tibia/fibula, proximal, extra-articular, avulsion (41-A1) 1. Of fibular head (41-A1.1) 2. Of tibial tuberosity (41-A1.2) 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) 3. Transverse (41-A2.3) A2 Tibia/fibula, proximal, extra-articular, multifragmentary metaphysis (41-A3) 1. Intact wedge (41-A3.1) 2. Fragmented wedge (41-A3.2) 3. Complex (41-A3.3) (1) lateral (1) lateral (1) slightly displaced (2) medial (2) medial (2) significantly displaced A3 S44 © 2007 Lippincott Williams & Wilkins J Orthop Trauma • Volume 21, Number 10 Supplement, November/December 2007 Tibia/Fibula Tibia/fibula, proximal, partial articular, split (41-B1) 1. Of lateral surface (41-B1.1) 2. Of medial surface (41-B1.2) 3. Oblique, involving the tibial spines (1) marginal (1) marginal and 1 of the surfaces (41-B1.3) (2) sagittal (2) sagittal (1) lateral (3) frontal anterior (3) frontal anterior (2) medial (4) frontal posterior (4) frontal posterior B1 Tibia/fibula, proximal, partial articular, depression (41-B2) 1. Lateral total (41-B2.1) 2. Lateral limited (41-B2.2) 3. Medial (41-B2.3) (1) 1 piece (1) peripheral (1) central (2) mosaic-like (2) central (2) anterior (3) anterior (3) posterior (4) posterior (4) total B2 Tibia/fibula, proximal, partial articular, split depression (41-B3) 1. Lateral (41-B3.1) 2. Medial (41-B3.2) 3. Oblique involving the tibial spines (1) antero-lateral depression (1) antero-lateral depression and 1 of the surfaces (41-B3.3) (2) postero-lateral depression (2) postero-lateral depression (1) lateral (3) antero-medial depression (3) antero-medial depression (2) medial (4) postero-medial depression (4) postero-medial depression B3 © 2007 Lippincott Williams & Wilkins S45 Tibia/Fibula J Orthop Trauma • Volume 21, Number 10 Supplement, November/December 2007 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 1. Slight displacement (41-C1.1) 2. 1 condyle displaced (41-C1.2) 3. Both condyles displaced (41-C1.3) C1 Tibia/fibula, proximal, complete articular, articular simple, metaphysis multifragmentary (41-C2) 1. Intact wedge (41-C2.1) 2. Fragmented wedge (41-C2.2) 3. Complex (41-C2.3) (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 © 2007 Lippincott Williams & Wilkins J Orthop Trauma • Volume 21, Number 10 Supplement, November/December 2007 Tibia/Fibula BONE: TIBIA/FIBULA (4) Location: Diaphyseal segment (42) Types: A. Simple (42-A) B. Wedge (42-B) C. Complex (42-C) Groups: Tibia/fibula, diaphyseal, simple (42-A) Tibia/fibula, diaphyseal, wedge (42-B) Tibia/fibula, diaphyseal, complex (42-C) 1. Spiral (42-A1) 2. Oblique 3. Transverse 1. Spiral wedge 2. Bending 3. Frag- 1. Spiral 2. Segmented 3. Irregular Ն ( 30°) (42-A2) (Ͻ30°) (42-B1) wedge (42-B2) mented (42-C1) (42-C2) (42-C3) (42-A3) wedge (42-B3) © 2007 Lippincott Williams & Wilkins S47 Tibia/Fibula J Orthop Trauma • Volume 21, Number 10 Supplement, November/December 2007 Subgroups and Qualifications: 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 3. Fibula fracture at same level (42-A1.2) (42-A1.3) A1 Tibia/fibula, diaphyseal, simple, oblique (Ն30°) (42-A2) (1) proximal zone (2) middle zone (3) distal zone 1. Fibula intact (42-A2.1) 2. Fibula fracture at different level 3. Fibula fracture at same level (42-A2.2) (42-A2.3) A2 Tibia/fibula, diaphyseal, simple, transverse (<30°) (42-A3) (1) proximal zone (2) middle zone (3) distal zone 1. Fibula intact (42-A3.1) 2. Fibula fracture at different level 3. Fibula fracture at same level (42-A3.2) (42-A3.3) A3 S48 © 2007 Lippincott Williams & Wilkins J Orthop Trauma • Volume 21, Number 10 Supplement, November/December 2007 Tibia/Fibula Tibia/fibula, diaphyseal, wedge, spiral (42-B1) (1) proximal zone (2) middle zone (3) distal zone 1. Fibula intact (42-B1.1) 2. Fibula fracture at different level 3. Fibula fracture at same level (42-B1.2) (42-B1.3) B1 Tibia/fibula, diaphyseal, wedge, bending (42-B2) (1) proximal zone (2) middle zone (3) distal zone 1. Fibula intact (42-B2.1) 2. Fibula fracture at different level 3. Fibula fracture at same level (42-B2.2) (42-B2.3) B2 Tibia/fibula, diaphyseal, wedge fragmented (42-B3) (1) proximal zone (2) middle zone (3) distal zone 1. Fibula intact (42-B3.1) 2. Fibula fracture at different level 3. Fibula fracture at same level (42-B3.2) (42-B3.3) B3 © 2007 Lippincott Williams & Wilkins S49 Tibia/Fibula J Orthop Trauma • Volume 21, Number 10 Supplement, November/December 2007 Tibia/fibula, diaphyseal, complex, spiral (42-C1) (1) pure diaphyseal (2) proximal diaphysio-metaphysis (3) distal diaphysio-metaphysis 1. With 2 intermediate fragments 2. With 3 intermediate fragments 3. With more than 3 intermediate (42-C1.1) (42-C1.2) fragments (42-C1.3) C1 Tibia/fibula, diaphyseal, complex segmental (42-C2) 1. With an intermediate segmental 2. With an intermediate segmental 3. With 2 intermediate segmental fragment (42-C2.1) and additional wedge fragment(s) fragments (42-C2.3) (1) pure diaphyseal (42-C2.2) (1) pure diaphyseal (2) proximal diaphysio-metaphyseal (1) pure diaphyseal (2) proximal diaphysio-metaphyseal (3) distal diaphysio-metaphyseal (2) proximal diaphysio-metaphyseal (3) distal diaphysio-metaphyseal (4) oblique lines (3) distal diaphysio-metaphyseal (5) transverse and oblique lines (4) distal wedge (5) 3 wedges, proximal and distal C2 Tibia/fibula, diaphyseal, complex, irregular (42-C3) 1. With 2 or 3 intermediate fragments 2. Limited shattering (Ͻ4cm) 3. Extensive shattering (Ͼ4cm) (42-C3.1) (42-C3.2) (42-C3.3) (1) 2 intermediate fragments (1) pure diaphyseal (2) 3 intermediate fragments (2) proximal diaphysio-metaphyseal (3) distal diaphysio-metaphyseal C3 S50 © 2007 Lippincott Williams & Wilkins J Orthop Trauma • Volume 21, Number 10 Supplement, November/December 2007 Tibia/Fibula BONE: TIBIA/FIBULA (4) Location: Distal segment (43) Types: A. Extra-articular (43-A) B. Partial articular (43-B) C. Complete articular (43-C) Groups: Tibia/fibula, distal, extra-articular (43-A) Tibia/fibula, distal, partial articular (43-B) Tibia/fibula, distal, complete articular (43-C) 1. Metaphyseal 2. Metaphy- 3. Metaphy- 1. Pure split 2. Split de- 3. Multifragmen- 1. Articular 2. Articular 3. Articular simple (43-A1) seal wedge seal complex (43-B1) pression tary depression simple, meta- simple, meta- multifragmen- (43-A2) (43-A3) (43-B2) (43-B3) physis simple physis multi- tary (43-C3) (43-C1) fragmentary (43-C2) © 2007 Lippincott Williams & Wilkins S51 Tibia/Fibula J Orthop Trauma • Volume 21, Number 10 Supplement, November/December 2007 Subgroups and Qualifications: 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) 2. Oblique (43-A1.2) 3. Transverse (43-A1.3) A1 Tibia/fibula, distal, extra-articular, wedge (43-A2) (1) fibula intact (2) simple fracture of fibula (3) multifragmentary fracture of fibula (4) bifocal fracture of fibula 1. Posterolateral impaction (43-A2.1) 2. Anteromedial wedge (43-A2.2) 3. Extending into diaphysis (43-A2.3) A2 Tibia/fibula, distal, extra-articular, complex (43-A3) (1) fibula intact (2) simple fracture of fibula (3) multifragmentary fracture of fibula (4) bifocal fracture of fibula 1. With 3 intermediate fragments 2. More than 3 intermediate frag- 3. Extending into diaphysis (43-A3.3) (43-A3.1) ments (43-A3.2) A3 S52 © 2007 Lippincott Williams & Wilkins J Orthop Trauma • Volume 21, Number 10 Supplement, November/December 2007 Tibia/Fibula Tibia/fibula, distal, partial articular, pure split (43-B1) (1) fibula intact (2) simple fracture of fibula (3) multifragmentary fracture of fibula (4) bifocal fracture of fibula 1. Frontal (43-B1.1) 2. Sagittal (43-B1.2) 3. Metaphyseal multifragmentary (5) anterior (5) lateral (43-B1.3) (6) posterior (Volkmann) (6) medial (medial malleolus) B1 Tibia/fibula, distal, partial articular, split depression (43-B2) (1) fibula intact (2) simple fracture of fibula (3) multifragmentary fracture of fibula (4) bifocal fracture of fibula 1. Frontal (43-B2.1) 2. Sagittal (43-B2.2) 3. Of the central fragment (43-B2.3) (5) anterior (5) lateral (6) posterior (6) medial B2 Tibia/fibula, distal, partial articular, depression (43-B3) (1) fibula intact (2) simple fracture of fibula (3) multifragmentary fracture of fibula (4) bifocal fracture of fibula 1.