Aménager les villes : réduire les fractures sociales et spatiales
L'extension urbaine s'est ensuite poursuivie le long des axes de transports reliant la ville à sa périphérie. • L'étalement urbain s'est caractérisé par le
Journée magistère du mardi 10 mars 2015 « Les territoires de l
10 mars 2015 Fractures territoriales et fractures scolaires à Marseille ... urbaine et résidentielle à Marseille (dir E Dorier et S.
Fracture numérique: essai de définition et regard critique sur
21 sept. 2017 1.1 Quelques définitions de la fracture numérique ... pays (à l'intérieur même des sociétés entre les milieux urbains et périphériques y ...
Fractures et transitions : réconcilier la France
12 mars 2019 populations concernées peuvent participer à la définition de l'intérêt ... augmenté de 47 % dans les 13 plus grandes aires urbaines de ...
LA COVID-19 ACCELERATRICE ET AMPLIFICATRICE DES
24 oct. 2020 Chercheur affilié au Laboratoire de sociologie urbaine ... De la fracture numérique aux fractures numériques.
La VEBE à Nancy: de la couture à la fracture urbaine (1976-2021)
6 sept. 2022 La VEBE à Nancy: de la couture à la fracture urbaine (1976-2021). ... Le dictionnaire Robert pose comme définition à la couture ...
Untitled
14 déc. 2017 La définition de l'intérêt métropolitain ne concerne donc que : ... réduction des fractures urbaines du territoire métropolitain.
La nouvelle question urbaine
fracture urbaine » semble ainsi prendre la relève de celle de frac ture sociale. espaces publics disparaissent au profit d'une définition fonctionnelle.
E2.1 –Les fractures du lextrémité supérieure du fémur.
L'incidence de cette fracture est variable d'un pays à l'autre et d'une race à une autre. Les pays industrialisés les zones urbaines
Protocole dengagements réciproques renforcés entre lÉtat et la
nombreux partenaires dans la lutte contre les fractures urbaines et sociales. demandeurs d'emploi (définition Insee) était deux fois plus élevée dans ...
Fracture Classifications - Orthopaedic Trauma Association (OTA)
• Type I:all fractures with
Fracture Classification - Orthopaedic Trauma Association (OTA)
Builds a description of the fracture in an organized easy to use manner Classification of Soft Tissue Injury Associated with Fractures Closed Fractures Fracture is not exposed to the environment All fractures have some degree of soft tissue injury Commonly classified according to the Tscherne classification
Department of Radiology – University of Wisconsin School of
Department of Radiology – University of Wisconsin School of
Anatomical Sites of Fractures
Long bones are divided into different anatomical areas (Fig. 8.1) and fractures can occur in one or multiple of these sites. The long bone shaft is called the diaphysis with each end called an epiphysis, while an area between the epiphysis and diaphysis, the neck in long bones, is called the metaphysis. In children there is the presence of growth p...
Fracture Correlation with Joints
An articular fracture involves the joint surface and is typically described in relation to the percentage of the joint space that is disrupted [1]. Intra-articular fractures are a bone fracture that crosses into the joint surface. Hemarthrosis (Fig. 8.2), bleeding into the joint space, can be a consequence of intra-articular fractures. Hemarthrosis...
Fracture Types
There are a variety of terms that can be used to describe the types of fractures that occur. Fractures that circumferentially traverse the shaft of bone perpendicular to the axis are transverse fractures and can be with or without displacement [6]. Spiral fractures are produced by rotational or twisting forces, while compression fractures are crump...
Fracture Displacement
Fracture displacements refer to the position of the fractured bone in relation to the normal anatomic configuration. Fractures without any abnormal anatomic configuration are nondisplaced. Displaced fractures show a separation of the fragment(s) with a loss of anatomic position of the distal fragment with respect to the proximal fragment. The amoun...
Open Versus Closed Fractures
Closed fractures indicate a fracture area that does not visibly communicate externally to the body (e.g., intact skin pattern). Open fractures communicate externally to the body and the break in the skin pattern may be very subtle (Fig. 8.5) or an obvious open wound (Fig. 8.6). Open fractures are an urgent situation and evaluation should commence f...
Pediatric Considerations
Greenstick Fracture
What is a bone fracture?
The fracture is a portion of the bone on one side, while the opposing side of the same bone will have a buckled or bowed appearance. The fracture itself does not cross through the width of the bone. These typically occur in the long bones and require immobilization and casting as quickly as possible following confirmation.
What are the classifications of fractures?
The purpose of this chapter is to discuss the various classifications of fractures that are based on distinct characteristics such as the anatomic site, the visual appearance (open versus closed), the radiographic appearance (e.g., displaced, compressed, fragmented), and the positioning and alignment of fragments if present.
What is a diaphyseal fracture?
A fracture of the humeral shaft (diaphyseal segment) is defined as any humeral fracture in which the major fracture line does not extend to within one metaphyseal width (Müller box) of either the shoulder or elbow joint; this is consistent with the Arbeitsgemeinschaft für Osteosynthesefragen definition , and is illustrated in Fig. 2. ... ...
How are fractures evaluated and managed?
Evaluation and management of fractures on or off the field must always include consideration of the anatomical site, the proximity to articulations, and complexity of the fracture. This is often assessed by simple visual inspection (open versus closed) and subsequent imaging modalities (e.g., type, displacement).
Fracture Classification
Lisa K. Cannada MD
Updated: 05/2016
History of Fracture
Classification
•18 th & 19 th century -History based on clinical appearance of limb aloneColles Fracture Dinner Fork Deformity
20 thCentury
•Classification based on radiographs of fractures •Many developed •Problems -Radiographic quality -Injury severityWhat about CT scans?
•CT scanning can assist with fracture classification •Example: Sanders classification of calcaneal fracturesOther Contributing Factors
The Soft Tissues
Fracture appears non
complex on radiographsThe real injury
Patient Variables
•Age •Gender •Diabetes •Infection •Smoking •Medications •Underlying physiologyInjury Variables
•Severity •Energy of Injury •Morphology of the fracture •Bone loss •Blood supply •Location •Other injuriesWhy Classify?
•As a treatment guide •To assist with prognosis •To speak a common language with other surgeonsAs a Treatment Guide
•If the same bone is broken, the surgeon can use a standard treatment •PROBLEM: fracture personality and variation with equipment and experienceTo Assist with Prognosis
•You can tell the patient what to expect with the results •PROBLEM: Does not consider the soft tissues or other compounding factorsTo Speak A Common
Language
•This will allow results to be compared •PROBLEM: Poor interobserver reliability with existing fracture classificationsInterobserver Reliability
Different physicians agree on
the classification of a fracture for a particular patientIntraobserver Reliability
For a given fracture, each
physician should produce the same classificationDescriptive Classification
Systems
•Examples -Garden: femoral neck -Schatzker: Tibial plateau -Neer: Proximal Humerus -Lauge-Hansen: AnkleLiterature
•94 patients with ankle fractures •4 observers •Classify according to Lauge Hansen and Weber •Evaluated the precision (observer's agreement with each other)Thomsen et al, JBJS
-Br, 1991Literature
•Acceptable reliabilty with both systems •Poor precision of staging, especialy PA injuries •Recommend: classification systems should have reliability analysis before usedThomsen et al, JBJS
-Br, 1991Literature
•Classified identical22/100
•Disagreement b/t displaced and non- displaced in 45 •Conclude poor ability to stage with this system •100 femoral neck fractures •8 observers •Garden's classificationFrandsen, JBJS
-B, 1988Universal Fracture
Classification
OTA Classification
•There has been a need for an organized, systematic fracture classification •Goal: A comprehensive classification adaptable to the entire skeletal system! •Answer: OTA Comprehensive Classification of Long Bone FracturesWith a Universal
Classification...
To...Treatment
Implant options
Results
You go from x
-ray....To Classify a Fracture
•Which bone? •Where in the bone is the fracture? •Which type? •Which group? •Which subgroup?Using the OTA Classification
•Which bone? •Where in the bone?Proximal & Distal Segment
Fractures
•Type A -Extra-articular •Type B -Partial articular •Type C -Complete disruption of the articular surface from the diaphysisDiaphyseal Fractures
•Type A -Simple fractures with two fragments •Type B -Wedge fractures -After reduced, length and alignment restored •Type C -Complex fractures with no contact between main fragmentsGrouping-Type A
1.Spiral
2.Oblique
3.Transverse
Grouping-Type B
1.Spiral wedge
2.Bending wedge
3.Fragmented wedge
Grouping-Type C
1.Spiral
multifragmentary wedge2.Segmental
3.Irregular
Subgrouping
•Differs from bone to bone •Depends on key features for any given bone and its classification •The purpose is to increase the precision of the classificationOTA Classification
•It is an evolving system •Open for change when appropriate •Allows consistency in research •Builds a description of the fracture in an organized, easy to use mannerClassification of Soft Tissue
Injury Associated with
Fractures
Closed Fractures
•Fracture is not exposed to the environment •All fractures have some degree of soft tissue injury •Commonly classified according to the Tscherne classification •Don't underestimate the soft tissue injury as this affects treatment and outcome!Closed Fracture Considerations
•The energy of the injury •Degree of contamination •Patient factors •Additional injuriesTscherne Classification
•Grade 0 -Minimal soft tissue injury -Indirect injury •Grade 1 -Injury from within -Superficial contusions or abrasionsTscherne Classification
•Grade 2 •Direct injury •More extensive soft tissue injury with muscle contusion, skin abrasions •More severe bone injury (usually)Tscherne Classification
•Grade 3 -Severe injury to soft tisues --degloving with destruction of subcutaneous tissue and muscle -Can include a compartment syndrome, vascular injuryClosed tibia fracture
Note periosteal stripping
Compartment syndrome
Literature
•Prospective study •Tibial shaft fractures treated by intramedullary nail •Open and closed •100 patientsGaston, JBJS
-B, 1999Literature
What predicts
outcome?Classifications
used: -AO -Gustilo -Tscherne -Winquist-Hansen (comminution)All x-rays reviewed by
single physicianEvaluated outcomes
UnionAdditional surgery
Infection
Tscherne classification
more predictive of outcome than othersGaston, JBJS
-B, 1999Open Fractures
•A break in the skin and underlying soft tissue leading into or communicating with the fracture and its hematomaOpen Fractures
•Gustilo-Anderson •OTA-OpenFracture
Classification
(OFC)Open Fractures
•Commonly described by the Gustilo system •Model is tibia fractures •Routinely applied to all types of open fractures •Gustilo emphasis on size of skin injuryOpen Fractures
•Gustilo classification used for prognosis •Fracture healing, infection and amputation rate correlate with the degree of soft tissue injury by Gustilo •Fractures should be classified in the operating room at the time of initial debridement -Evaluate periosteal stripping -Consider soft tissue injuryType I Open Fractures
•Inside-out injury •Clean wound •Minimal soft tissue damage •No significant periosteal strippingType II Open Fractures
•Moderate soft tissue damage •Outside-in mechanism •Higher energy injury •Some necrotic muscle, some periosteal strippingType IIIA Open Fractures
•High energy •Outside-in injury •Extensive muscle devitalization •Bone coverage with existing soft tissue not problematicNote Zone of Injury
Type IIIB Open Fractures
•High energy •Outside in injury •Extensive muscle devitalization •Requires a local flap or free flap for bone coverage and soft tissue closure •Periosteal strippingType IIIC Open Fractures
•High energy •Increased risk of amputation and infection •Major vascular injury requiring repair •245 surgeons •12 cases of open tibia fractures •Videos used •Various levels of training (residents to trauma attendings)Brumback et al, JBJS-A, 1994
Literature on Open Fracture Classification
Literature on Open Fracture Classification
•Interobserver agreement poor -Range 42-94% for each fracture •Least experienced-59% agreement
•Orthopaedic Trauma Fellowship trained-66% agreement
Brumback et al, JBJS-A, 1994
New Lecture on the OTA
Open Fracture
Classification:
•For questions or comments, please send to ota@ota.orgReturn to
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