Table Of Contents - AO/OTA Fracture And Dislocation Classification .
Table of contentsHumerus 5This PDF version has been formatted for personal use.Radius 9Ulna 13To order the high-quality printed version of the booklet,please contact us at: publishing@aofoundation.orgFemur 17AO/OTA Fracture andDislocation ClassificationTibia 21Fibula 25Malleolar segment 25Introduction to the classification oflong-bone fracturesCoding—bone and location 28Alphanumeric structure of the AO/OTA classification 29Definitions of fracture types for long-bone fracturesin adults 30Describing the fracture morphology—types of end-segment fractures 32Describing the fracture morphology—types of diaphyseal fractures 34Universal modifiers 36Qualifications 38Reference 39Copyright 2018 by AO Foundation, SwitzerlandCheck hazards and legal restrictions on www.aofoundation.org/legalAOE-E1-018.9
Humerus111 Proximal end segment11A11A111A211A3Extraarticular, unifocal, 2-partTuberositySurgical neckVertical11B Extraarticular, bifocal, 3-part11B1 Surgical neck11C Articular or 4-part11C1 Anatomical neck11C3 Anatomical neck associated with metaphyseal fracture11A111A211A311B111C111C312 Diaphyseal segment12A12A1*12A2*12A3* 30 SimpleSpiralOblique ( 30 )Transverse ( 30 )12B Wedge12B2* Intact wedge12B3* Fragmentary wedge 30 12C Multifragmentary12C2* Intact segmental12C3* Fragmentary segmental12A112A212A312B212B312C212C3* Qualifications:12A and 12B: a Proximal 1/3, b Middle 1/3, c Distal 1/312C: i Proximal diaphyseal-metaphyseal, j Pure diaphyseal, k Distal diaphyseal-metaphyseal13 Distal end segment13A Extraarticular13A1 Avulsion13A2 Simple13A3 Wedge or multifragmentary13B Partial articular13B1 Lateral sagittal13B2 Medial sagittal13B3 Frontal/coronal plane13A1513A213A313B1AO/OTA Fracture and Dislocation Classification Long-bone Fractures13B213B313C113C213C Complete articular13C1 Simple articular, simple metaphyseal13C2 Simple articular, wedge or multifragmentary metaphyseal13C3 Multifragmentary articular, wedge or multifragmentary metaphyseal13C367
Radius2R2R1 Proximal end segment2R1A2R1A12R1A22R1A3ExtraarticularAvulsion of bicipital tuberosityNeck, simpleNeck, multifragmentary2R1B Partial articular2R1B1 Simple2R1B3 Fragmentary2R1A12R1A22R1A32R1B12R1B32R1C12R1C Complete articular2R1C1 Simple2R1C3 Multifragmentary2R1C32R2 Diaphyseal segment2R2A2R2A1*2R2A2*2R2A3*2R2B Wedge2R2B2* Intact wedge2R2B3* Fragmentary wedge 30 30 SimpleSpiralOblique ( 30 )Transverse ( 30 )2R2C Multifragmentary2R2C2* Intact segmental2R2C3* Fragmentary segmental2R2A12R2A22R2A32R2B22R2B32R2C22R2C3* Qualifications:2R2A and 2R2B: a Proximal 1/3, b Middle 1/3, c Distal 1/32R2C: i Proximal diaphyseal-metaphyseal, j Pure diaphyseal, k Distal diaphyseal-metaphysealp2R3 Distal end segmentpa2R3A2R3A12R3A22R3A3aExtraarticularRadial styloid avulsionSimpleWedge or multifragmentary2R3B Partial articular2R3B1 Sagittal2R3B2 Dorsal rim (Barton's)2R3B3 Volar rim (reverse Barton's, Goyrand-Smith's II)2R3A192R3A22R3A32R3B1AO/OTA Fracture and Dislocation Classification Long-bone 3C310Complete articularSimple articular and metaphysealMultifragmentary metaphysealMultifragmentary articular, simple or multifragmentary metaphyseal11
2UUlna2U1 Proximal end segment2U1A2U1A12U1A22U1A3ExtraarticularAvulsion of triceps insertionSimple metaphysealMultifragmentary metaphyseal2U1B Partial articular2U1B1* Olecranon2U1B2* Coronoid2U1C Complete articular2U1C3* Olecranon and coronoid2U1A12U1A22U1A32U1B12U1B22U1C3* Qualifications:B1: d Simple, e MultifragmentaryB2: n Involving sublime facet, o Tip (avulsion), p 50%, q 50%C3: d Simple, r Multifragmentary olecranon, s Multifragmentary involving coronoid process2U2 Diaphyseal segment2U2A Simple2U2A1* Spiral2U2A2* Oblique ( 30 )2U2A3* Transverse ( 30 ) 30 2U2B Wedge2U2B2* Intact wedge2U2B3* Fragmentary wedge 30 2U2C Multifragmentary2U2C2* Intact segmental2U2C3* Fragmentary segmental2U2A12U2A22U2A32U2B22U2B32U2C22U2C3* Qualifications:2U2A and 2U2B: a Proximal 1/3, b Middle 1/3, c Distal 1/32U2C: i Proximal diaphyseal-metaphyseal, j Pure diaphyseal, k Distal diaphyseal-metaphyseal2U3 Distal end segment2U3A2U3A12U3A22U3A3 2U3A1132U3A2ExtraarticularStyloid processSimpleMultifragmentary2U3BPartial articular2U3CComplete articular30 2U3A3AO/OTA Fracture and Dislocation Classification Long-bone Fractures2U3B2U3C1415
Femur331 Proximal end segment31A Trochanteric region31A1 Simple pertrochanteric31A2 Multifragmentary pertrochanteric, lateral wall incompetent ( 20.5 mm)31A3 Intertrochanteric (reverse 1C1Femoral neckSubcapitalTranscervicalBasicervical31C Femoral head31C1 Split31C2 Depression31C232 Diaphyseal segment32A32A1*32A2*32A3*32B Wedge32B2* Intact wedge32B3* Fragmentary wedge 30 30 SimpleSpiralOblique ( 30 )Transverse ( 30 )32C Multifragmentary32C2* Intact segmental32C3* Fragmentary segmental32A132A232A332B232B332C232C3* Qualifications:32A and 32B: a Proximal 1/3, b Middle 1/3, c Distal 1/332C: i Proximal diaphyseal-metaphyseal, j Pure diaphyseal, k Distal diaphyseal-metaphyseal33 Distal end segment33A11733A233A333B1AO/OTA Fracture and Dislocation Classification Long-bone ularAvulsionSimpleWedge or multifragmentary33B33B133B233B3Partial articularLateral condyle, sagittalMedial condyle, sagittalFrontal/coronal33C Complete articular33C1 Simple articular, simple metaphyseal33C2 Simple articular, wedge or multifragmentary metaphyseal33C3 Multifragmentary articular, simple, wedge or multifragmentarymetaphyseal33C31819
Tibia41A141A241A3pppppaaaaa41B141B241B341C141C2441 Proximal end Wedge or multifragmentary41B41B141B241B3Partial articularSplitDepressionSplit depression41C Complete articular41C1 Simple articular, simple metaphyseal41C2 Simple articular, wedge or multifragmentary metaphyseal41C3 Fragmentary or multifragmentary metaphyseal41C342 Diaphyseal segment42A42A1*42A2*42A3*42B Wedge42B2* Intact wedge42B3* Fragmentary wedge 30 30 SimpleSpiralOblique ( 30 )Transverse ( 30 )42C Multifragmentary42C2 Intact segmental42C3* Fragmentary segmental42A142A242A342B242B342C242C3* Qualifications:42A and 42B: a Proximal 1/3, b Middle 1/3, c Distal 1/342C: i Proximal diaphyseal-metaphyseal, j Pure diaphyseal, k Distal diaphyseal-metaphyseal43 Distal end SimpleWedgeMultifragmentaryPartial articularSplitSplit depressionDepressionaa43B43B143B243B3pp43B143B243C Complete articular43C1 Simple articular, simple metaphyseal43C2 Simple articular, multifragmentary metaphyseal43C3 Multifragmentary articular and multifragmentary metaphysealAO/OTA Fracture and Dislocation Classification Long-bone Fractures43B343C143C243C32223
Fibula4F4F1 Proximal end segment4F1A* Simple4F1B* Multifragmentary4F2 Diaphyseal segment4F2A* Simple4F2B* Wedge or multifragmentary4F3 Distal end segment4F1A4F1B4F2A4F2B4F3A4F3A Simple4F3B Wedge or multifragmentary4F3B* Qualifications:4F1: n Extraarticular, o Intraarticular4F2: a Proximal 1/3, b Middle 1/3, c Distal 1/3Malleolar segmentaapp44A44A144A244A344Infrasyndesmotic fibula injuryIsolated fibula injuryWith medial malleolar fractureWith posteromedial fracture44B Transsyndesmotic fibula fracture44B1 Simple fibula fracture44B2 With medial injury44B3 With medial injury and fracture of the posterolateral rim(Volkmann's fragment)44C Suprasyndesmotic fibula fracture44C1 Simple diaphyseal fibula fracture44C2 Wedge or multifragmentary diaphyseal fibula fracture44C3 Proximal fibula injury44A12544A244A344B1AO/OTA Fracture and Dislocation Classification Long-bone Fractures44B244B344C144C244C32627
Coding—bone and locationAlphanumeric structureof the AO/OTA classificationCraniomaxillofascial bones 9Thorax 16LocalizationClavicle 1511Scapula14Humerus 1DiagnosisX-rays, CT scan, MRI as required, operative alifications) [Universal modifiers]12For further information about refined coding of themorphology of the fracture to subgroup level and applyinguniversal modifiers and qualifications, please consult theJournal of Orthopaedic Trauma, 2018 Supplement 1,available online.13Spine 5Pelvis 6 2U12R12U2Ulna 2U312U3322R2Radius 2R2R3Hand r 333Patella 344142434F14F24F3Malleolus 44Foot 82844Tibia 4Fibula 4FAO/OTA Fracture and Dislocation Classification Long-bone FracturesThe anatomical location of the fracture is designated bytwo numbers: one for the bone and one for its segment.The tibia is an exception with the malleoli representinga fourth segment (44).The proximal and the distal segments of long bones aredefined by a square whose sides have the same length asthe widest part of the epiphysis (exception: 31).29
Definitions of fracture typesfor long-bone fractures in adultsSegmentTypeAABAABBCB CCCProximal1Extraarticular ExtraarticularExtraarticularPartial articularPartial articularPartialCompletearticulararticularComplete Completearticular articularPartial articularExtraarticularComplete articularPartial articular—type B, when the fracture involves onepart of the articular surface while the remainder of the jointremains attached to the metaphysis and traarticular ExtraarticularExtraarticularPartial articularPartial articularPartialCompletearticulararticularComplete articularComplete type A, when the fracture does not involvethe joint surface.AABBBCPartial articularCCComplete articularAO/OTA Fracture and Dislocation Classification Long-bone FracturesComplete articular—type C, when the fracture hasdisrupted the joint surface, which is completely separatedfrom the diaphysis.Simple—type A, fracture with a single circumferentialfracture.Wedge—type B, fracture with one or more intermediatefragments. After reduction there is some cortical contactbetween the main proximal and distal fragments.Multifragmentary—type C, with one or more intermediatefragments. After reduction there is no contact between themain proximal and distal fragments.31
Describing the fracturemorphology—typesof end-segment fracturesTypeSteps in identifying end-segment QuestionAnswer1What is the bone?Specific bone number, see skeleton2At which end is the fracture Proximal (1)located?Distal (3)3Type: Does the fractureenter the joint surface?No—extraarticular (A), go to step 5Yes—articular (B or C), go to step 44aType: If articular, is it partial(part of joint attached tometaphysis)?Yes (type B), go to step 64bType: If articular, is itcomplete (no part of jointattached to metaphysis)?Yes (type C), go to step 75Group: If extraarticular (A),what is the fracturepattern?Avulsion (1)Simple (2)Wedge or multifragmentary (3)6Group: If partial articular(B), what is the fracturepattern?Simple (1)Split and/or depression (2)Fragmentary (3)7Group: If complete articular Simple (1)(C), what is the articularMultifragmentary (2 and 3)fracture pattern?8Add qualifications and/oruniversal modifiersMultifragmentaryPartial articularBSimpleSplit depressionFragmentaryComplete articularCSimple articular,simplemetaphyseal32Split taryarticular,multifragmentarymetaphysealAO/OTA Fracture and Dislocation Classification Long-bone Fractures33
Describing the fracturemorphology—typesof diaphyseal fracturesTypeSteps in identifying diaphyseal fracturesGroup123SimpleA 30 SpiralOblique 30 StepQuestionAnswer1What is the bone?Specific bone number, see skeleton2Is the fracture at the endor middle segment?Middle—diaphyseal segment (2)3What is the type?Simple (A)Wedge (B)Multifragmentary (C)4aGroup: If simple (A), whatis the fracture pattern?Spiral (1)Oblique (2)Transverse (3)4bGroup: If wedge (B), what Intact (2)is the fracture pattern?Fragmentary (3)4cGroup: If multifragmentary Intact segmental (2)(C), what is the fractureFragmentary segmental (3)pattern?5Add qualifications and/oruniversal TA Fracture and Dislocation Classification Long-bone Fractures35
Universal modifiersList of universal modifiers1Nondisplaced2Displaced33a3bThe universal modifiers are descriptive terms offracture morphology, displacement, associatedinjury, or location that are generalizable to mostfractures. They provide details that are optionalfor users. 4No impaction5Universal modifiers may be added to the end of the fracturecode within square brackets, eg, [1].Multiple universal modifiers may be contained within the sameset of square brackets and separated by a comma.5a5b5c5d5e5fDislocationAnterior (volar, palmar, plantar)Posterior (dorsal)Medial (ulnar)Lateral (radial)Inferior (with hip is also ligamentous instabilityAnterior (volar, palmar, plantar)Posterior (dorsal)Medial (ulnar)Lateral (radial)Inferior (with hip is also obturator)Multidirectional67Diaphyseal extension88a8b8cExample8dA proximal humeralfracture dislocation withdisplacement, anteriordislocation, cartilageinjury, and physeal8eArticular cartilage injury#ICRS Grade 0NormalICRS Grade 1 Superficial indentation (A) and/or superficialfissures and cracks (B)ICRS Grade 2 Abnormal lesions extending down to 50% ofcartilage depthICRS Grade 3 Severely abnormal with defects extending down 50% of cartilage depth (A); down to calcifiedlayer (B); down to subchondral bone but notthrough (C); blisters included (D)ICRS Grade 4 Severely abnormal cartilage loss throughsubchondral bone9Poor bone quality10Replantation11Amputation associated with a fracture12Associated with a nonarthroplasty implant13Spiral type fracture14Bending type fractureThis grading system is used with the permission of the International Cartilage Repair Society (ICRS).#36AO/OTA Fracture and Dislocation Classification Long-bone Fractures37
QualificationsReferenceQualifications are descriptive terms of fracturemorphology or location that are specific to eachfracture.Meinberg E, Agel J, Roberts C, et al. Fracture and DislocationClassification Compendium—2018. J Orthopaed Trauma. 2018Jan;32(Suppl 1). The revised AO/OTAClassification appnow available for iOS andAndroid mobile devicesQualifications are represented with lower-case letters todifferentiate them from the fracture type (which is always anupper-case letter).They are optional and applied to the fracture code where theasterisk is located as a lower-case letter within rounded brackets.More than one qualification can be applied, separated by acomma.The majority of qualifications are applied at subtype level.ExampleFemur, diaphyseal segment,simple, transverse fracture ( 30º)32A3(b)* Qualificationsa Proximal 1/3b Middle 1/3c DistalFor further educational material about the classificationand access to the complete Fracture and DislocationClassification Compendium, please use the QR code.38AO/OTA Fracture and Dislocation Classification Long-bone Fractures39
Complete articular—type C, when the fracture has disrupted the joint surface, which is completely separated from the diaphysis. Simple—type A, fracture with a single circumferential fracture. Wedge—type B, fracture with one or more intermediate fragments. After reduction there is some cortical contact
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