Klasyfikacja złamań powinna określać ciężkość, czyli morfologiczną złożoność złamania, wystąpienie potencjalnych trudności w leczeniu oraz rokowanie. Określenie tego jest możliwe, dzięki klasyfikacji na powtarzających się triadach typów złamań.
Klasyfikacja złamań wg AO opiera się o klasyfikację Müllera z 1990 roku. Głównym założeniem jej jest charakter generyczny oraz odniesienie do całego układu kostnego. Zgodnie z myślą przewodnią jej autora, klasyfikacja wartościowa jest tylko wtedy, kiedy jest w stanie racjonalnie uzasadnić podejmowane leczenie oraz pomóc w dokonywaniu oceny jego wyników.
Klasyfikacja zawiera 3 typy złamań o rosnącym stopniu złamania A, B, C. Każdy z nich dzieli się na 3 grupy A1, A2, A3/ B1, B2, B3/ C1, C2, C3. Natomiast każda z nich, na podgrupy A1.1, A1.2, A1.3, B1.1, B1.2 itd.
Zarówno grupy, jak i podgrupy uszeregowano zgodnie ze wzrastającym stopniem ciężkości złamań. To spowodowało, że niezwykle ważnego znaczenia klinicznego nabrało rozpoznanie typu złamania. Zgodnie z klasyfikacją, w obrębie kości długiej powinny znajdować się 3 segmenty, trzon oraz 2 segmenty obejmujące końce stawowe.
Segment 1 dotyczy bliższej części stawowej, segment 2 trzonu, a segment 3 dalszej części stawowej
Z uwagi na to, że trudno jednoznacznie określić granicę anatomiczną pomiędzy trzonem a nasadą, w klasyfikacji wykorzystuje się zasadę kwadratów, dzięki której możliwe jest niezwykle precyzyjne zdefiniowanie segmentu końcowego kości. Klasyfikacja ujęła również numerację poszczególnych kości ludzkiego szkieletu, zgodnie z którą nr 1 to kość ramienna, nr 2 – przedramię, nr 3 – udo, a nr 4 – podudzie.
Niezależnie od tego, czy złamania stawowe przebiegają wewnątrz czy zewnątrztorebkowo, określa się je jako te, które obejmują powierzchnię stawową. Najważniejszym czynnikiem, który określa obszar przynależny do stawu jest kwadrat. Zgodnie z klasyfikacją obejmuje on stawowy koniec kości utworzony przez najszerszy wymiar nasady. Wówczas każde złamanie, które wystąpiło w tym obszarze to złamanie stawowe.
Złamania stawowe dzielą się również na złamania częściowo lub całkowicie stawowe
Złamania znajdujące się w obszarze kwadratu, natomiast nie obejmujące powierzchni stawowej zwane są złamaniami pozastawowymi. Ze względu na to, że wpływają na oś stawu, zaliczane są do grupy A. Do złamań częściowo stawowych (grupa B) zalicza się natomiast złamania w których część powierzchni stawowej ma połączenie z główną kością. Ostatnia grupa całkowicie stawowa (C), charakteryzuje się zaś złamaniem stawowym w którym żaden ze złamanych fragmentów kostnych nie łączy się z pozostałą kością.
Źródło: ortopediaitraumatologia.pl
Przeczytaj także: Jakie powikłania mogą wystąpić po złamaniu kości?
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