The American Association for the Surgery of Trauma (AAST) injury scoring scales are the most widely accepted and used system of classifying and categorising traumatic injuries. Injury grade reflects severity, guides management, and aids in prognosis. At the time of writing (mid 2016), 32 differe...
The American Association for the Surgery of Trauma (AAST) renal injury scale 3-4 is the most widely used grading system for renal trauma at the time of writing (late 2016). Severity is assessed according to the depth of renal parenchymal damage and involvement of the urinary collecting system a...
The 1994 revision of the AAST (American Association for the Surgery of Trauma) liver injury scale is the most widely used liver injury grading system at the time of writing (late 2016).
haematoma: subcapsular, <10% surface area
laceration: capsular tear, <1 cm parenc...
The 1994 revision of the American Association for the Surgery of Trauma (AAST) splenic injury scale is the most widely used grading system for splenic trauma at the time of writing (late 2016).
subcapsular haematoma <10% of surface area
capsular laceration <1 cm depth...
The American Academy of Orthopedic Surgeons classification of periprosthetic hip fractures divides the femur into three separate regions:
level I: proximal femur distally to the lower extent of the lesser trochanter
level II: 10 cm of femur distal to level I
level III: femur distal to level...
The Anderson and D'Alonzo classification is the most commonly used classification of fractures of the odontoid process of C2.
fracture of the upper part of the odontoid peg
above the level of the transverse band of the cruciform ligament
usually considered stable...
Ankle fractures account for ~10% of fractures encountered in trauma, preceded only in incidence by proximal femoral fractures in the lower limb. They have a bimodal presentation, involving young males and older females. Ankle injuries play a major part in post multitrauma functional impairment t...
Anterior cruciate ligament (ACL) avulsion fractures or tibial eminence avulsion fractures are a type of avulsion fracture of the knee. This typically involves separation of the tibial attachment of the ACL to variable degrees. Separation at the femoral attachment is rare 5.
It is ...
The Biffl scale or grade illustrates the spectrum of blunt cerebrovascular injury (BCVI) seen on angiography (both CTA and DSA). Some authors refer to the grading scale as the Denver scale, which is not to be confused with the Denver criteria, a set of clinical and risk factors for BCVI.
There are several cervical spine fracture classification systems:
Anderson and D'Alonzo classification (odontoid fracture)
Roy-Camille classification (odontoid fracture)
Levine and Edwards classification (for traumatic injuries to axis)
Allen and Ferguson classification (subaxial spine inju...
Chauffeur fractures (also known as Hutchinson fractures or backfire fractures) are intra-articular fractures of the radial styloid process. The radial styloid is within the fracture fragment, although the fragment can vary markedly in size.
These injuries are sustained eit...
This classification of gamekeeper thumb (also known as skier thumb) was proposed by Hintermann et al 1 in 1993 and is based on whether a fracture is present and whether the injury is stable:
fracture present, which is non-displaced and stable in flexion
typically treated with a splint/...
There are several classification systems for sacral fractures, but the most commonly employed are the Denis classification and subclassification systems, and the Isler classification system. These classification systems are important to understand as proper classification can impact management.
Complex midfacial fractures consist of multiple facial fractures that cannot be classified as any of the known complex facial fracture (e.g. Le Fort, zygomaticomaxillary complex fracture, naso-orbital-ethmoid fracture).
The Cooke and Newman classification of periprosthetic hip fractures is a modification of the Bethea classification proposed several years earlier.
explosion type fracture, comminuted around the stem of the implant
the prosthesis is always loose and the fracture is inherently unstable
Degloving injuries can refer to a number of conditions:
degloving soft tissue injury
Morel-Lavallee lesion (closed degloving soft tissue injury)
intramuscular degloving injury
degloving bowel injury
Deltoid ligament injuries involve the deltoid ligament that forms the medial part of the ankle joint. It attaches the medial malleolus to multiple tarsal bones.
Mechanism of injury
It occurs due to eversion and/or pronation injury, or can be associated with lateral ankle fractures.
Distal fibula fractures are the commonest fracture at the ankle and are usually the result of an inversion injury with or without rotation. They are the extension of a lateral collateral ligament injury.
Most ankle injuries occur because of an inversion injury. A pu...
Facial fractures are commonly caused by blunt or penetrating trauma sustained during motor vehicle accidents, assaults, and falls. The facial bones are thin and light making them susceptible to injury.
Males are affected more commonly than females and facial fractures are most com...
The Genant classification of vertebral fractures is based on the vertebral shape, with respect to vertebral height loss involving the anterior, posterior, and/or middle vertebral body.
grade 0: normal
grade 1: mild fracture, 20% to 25% loss of height
grade 2: moderate fracture, 25% to 40% los...
The Gustilo Anderson classification, sometimes referred to as the Gustilo classification is the most widely accepted classification system of open (or compound) fractures.
The grading system is used to guide management of compound fractures, with higher grade injuries associated with higher ris...
The Johansson classification of periprosthetic hip fractures was the first classification system proposed and is the simplest. It is based on the level of the fracture in relation to the prosthesis.
type I: fracture proximal to the tip of the prosthesis with the stem still in contact with the m...
The Judet and Letournel classification is the most widely used classification of acetabular fractures.
It is based on three radiographic views (anteroposterior view, obturator oblique view and Iliac oblique view) and classifies acetabular fractures into ten major fracture patterns, which cons...
Lateral humeral condyle fractures are relatively common elbow fractures that predominantly occur in children.
They represent ~12.5% (range 5-20%) of elbow fractures in children and are the second most common paediatric elbow fracture after supracondylar fractures.
They occur in ...
Le Fort fractures are fractures of the midface, which collectively involve separation of all or a portion of the midface from the skull base. In order to be separated from the skull base the pterygoid plates of the sphenoid bone need to be involved as these connect the midface to the sphenoid bo...
The Magerl classification of thoracolumbar spinal fractures is based on the three column concept by Denis, and the McAfee classification. It relies exclusively on CT findings.
A: compression injuries
A1: impaction fractures
A1.1: endplate impaction
A1.2: wedge impaction
The Marshall classification of traumatic brain injury is a CT scan derived metric using only a few features and has been shown to predict outcome in patients with traumatic brain injury.
This system was first published in 1992 1 building on findings from a large cohort of head injury cases des...
Mayfield classification of carpal instability, also known as perilunate instability classification (carpal dislocations), describes carpal ligament injuries.
Instability has been divided into four stages 1-2:
stage I: scapholunate dissociation (rotatory subluxation of the scaphoid)
Mayo classification of scaphoid fractures divides them into three types according to anatomic location of the fracture line:
Fractures of the distal third are further divided into distal articular surface or the distal tubercle fractures:
The modified Memphis criteria are a set of screening criteria for blunt cerebrovascular injury (BCVI) in trauma. The presence of one or more of these criteria makes necessary a complementary CTA or DSA study to exclude a BCVI.
The screening protocol criteria for BCVI are:
base of skull fractur...
The Neer classification of proximal humeral fractures is probably the most frequently used along with the AO classification of proximal humeral fractures. Even if an exact knowledge of this classification system is beyond the everyday use of many radiologists, the terminology and factors which i...
Nerve injury classification describes the various features of nerve injury on MRI with respect to pathological events.
grade I: there is increased T2/STIR signal in the nerve, however the muscle appears normal
grade II: increased T2/STIR signal in ne...
Occipital condylar fractures result from high-energy blunt trauma.
The exact incidence of these fractures is unknown but are reported to occur in 3-4% patients with moderate-severe traumatic brain injuries 3.
History and examination are unreliable, and high...
Open book fracture of the pelvis is a pelvic fracture that results from an anteroposterior compression injury to the pelvis.
This causes disruption of pubic symphysis and the pelvis opens like a book. The pubic rami may be fractured in vertical orientation instead of the disruption o...
A number of pancreatic injury grading systems have been proposed.
American Association for the Surgery of Trauma (AAST)
grade 1: haematoma with minor contusion/laceration but without duct injury
grade 2: major contusion/laceration but without duct injury
grade 3: distal lace...
Harrington criteria can be used to predict which skeletal metastases are at high risk of pathological fracture and should undergo prophylactic internal fixation. It preceded the Mirel classification for impending pathological fracture but has not been validated and its use is debated.
Mirel classification is a system used to predict the highest risk of pathological fracture among bones affected by metastases.
involving <1/3 of bone diameter
involving 1/3-2/3 of bone diameter
Several classification systems have been proposed for periprosthetic fractures of the hip:
American Academy of Orthopedic Surgeons (AAOS) classification
Cooke and Newman (modified Bethea) classification
Vancouver classification: most widely used
Piedmont fractures have been variably defined in the literature. Many suggest that Piedmont fractures are synonymous with Galeazzi fractures. That is a fracture of the radius at the middle and distal third with associated disruption of the distal radioulnar joint.
The initial report about the s...
Pipkin classification is the most commonly used classification for femoral head fractures, which are uncommon but are associated with hip dislocations.
type I: fracture distal to the fovea capitis, a small fracture not involving the weightbearing surface
type II: fracture proxi...
Riseborough and Radin classification of intercondylar fractures of the humerus can be used to classify this injury, which is the result of direct trauma to the olecranon as it is driven as a wedge between the humeral condyles. Four types of fractures can be identified:
type I: no displacement ...
The Rotterdam CT score of traumatic brain injury is a relatively recently described classification aimed at improving prognostic evaluation of patients admitted with acute traumatic brain injuries.
It was published in 2006 1 and is gaining in popularity. Along with the Marshall classification ...
The Roy-Camille classification of fractures of the odontoid process of C2 depends on the direction of the fracture line 1.
The level of fracture line as described by the Anderson and D’Alonzo classification, is not predictive of the degree of instability or the risk of non-union. This classific...
The Sanders classification system is used to assess intraarticular calcaneal fractures, which are those involving the posterior facet of the calcaneus. This classification is based on the number of intraarticular fracture lines and their location on semicoronal CT images. This classification is ...
Schatzker classification system is one method of classifying tibial plateau fractures.
Increase in type number denotes increasing severity, reflecting not only increased energy imparted to the bone at the time of injury but also an increasingly worse prognosis 1. The most common fracture of the...
Supracondylar fractures are a classic paediatric injury which require vigilance as imaging findings can be subtle.
Simple supracondylar fractures are typically seen in younger children, and are uncommon in adults; 90% are seen in children younger than 10 years of age, with a peak ...
Temporal bone fractures are usually a sequela of blunt head injury, generally from severe trauma. Associated intracranial injuries, such as extra-axial haemorrhage, shear (or diffuse axonal) injury, and cerebral contusion are common. Early identification of temporal bone trauma is essential to m...
The thoracolumbar injury classification and severity score (TLICS) has been developed by the Spine Trauma Group to overcome some of the perceived difficulties regarding the use of other thoracolumbar spinal fracture classification systems for determining treatment 1.
There are several thoracolumbar spinal fracture classification systems:
three column concept of thoracolumbar spinal fractures (Denis classification)
thoracolumbar injury classification and severity score (TLICS)
McAfee classification of acute traumatic spinal injuries is based on the three column concept of the spine. CT is needed for accurate assessment.
wedge compression: isolated anterior column compression
stable burst: anterior and middle column compression but posterior column i...
The three column concept of thoracolumbar spinal fractures was initially devised by Francis Denis and presently CT is mandatory for an accurate classification.
While initially developed for classification of thoracolumbar spinal fractures, it can also be applied to the lower cervical spine 3 as...
Tillaux fractures are Salter-Harris III fractures through the anterolateral aspect of the distal tibial epiphysis, with variable amounts of displacement.
It occurs in older children and adolescents when the medial aspect of the distal tibial growth plate has started to fuse.
Triplane or triplanar fractures are of the distal tibia only occurring in adolescents. As the physiological closure of the physeal plate begins medially, the lateral (open) physis is prone to this type of fracture. The name is due to the fact of the fracture expanding both in frontal and lateral...
Trochanteric fracture is a fracture involving the greater and/or lesser trochanters of the femur.
Fractures in these region can be classified as:
greater trochanteric avulsion fracture
lesser trochanteric avulsion fracture
The Vancouver classification of periprosthetic hip fractures proposed by Duncan and Masri is the most widely used classification system. It takes into account the fracture site, the status of the femoral implant, and the quality of surrounding femoral bone stock.
type A: fractures involve the t...
The Winquist classification of femoral shaft fractures is based on fracture comminution and was proposed by Winquist in 1980. This classification is used with regards to management decision making, in determining whether a fracture requires an intramedullary nail or open reduction.
Type 0: no ...