Distal radius fracture classification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]

Overview

There are multiple classifications available for distal radius fractures. The most common classification systems for distal radius fractures include Frykman, Melone, Fernández, Universal, and AO classification.

Classification

There are multiple classifications available for distal radius fractures. The most common classification systems for distal radius fractures include Frykman (1967), Melone (1984), Fernández (2001), Universal (Cooney 1993), and AO classification (Marsh et al. 2007).

Frykman Classification

Frykman classified distal radius fracture based on location.^[1]

Frykman Classification
I	Extra-articular
II	Extra-articular with ulnar fracture
III	Intra-articular into radiocarpal joint
IV	Intra-articular into radiocarpal joint with ulnar fracture
V	Intra-articular into radioulnar joint
VI	Intra-articular into radioulnar joint with ulnar fracture
VII	Intra-articular into radiocarpal + radioulnar joints
VIII	Intra-articular into radiocarpal + radioulnar joints with ulnar fracture

Melone Classification

Melone classified distal radius fracture based on location.^[2]^[3]

Melone Classification
I	Undisplaced, no or minimal comminution
II	Die punch fracture with moderate to severe displacement
	A	Reducible
	B	Irreducible
III	Spike fragment present
IV	Wide separation of intra-articular fragments
V	Explosion fracture with severe comminution, transverse split and rotational displacement

Fernández Classification

Fernández classified distal radius fracture based on trauma mechanism.^[4]

Fernández Classification
Type 1	Bending fracture of metaphysis
Type 2	Shearing fracture of joint surface
Type 3	Compression fracture of joint surface
Type 4	Avulsion fractures or radiocarpal fracture-dislocation
Type 5	Combined fractures associated with high high-velocity injuries

Universal Classification

Cooney classified distal radius fracture based on location and stability.^[5]

Universal Classification
Type 1	Extra-articular fracture, without deviation
Type 2	Extra-articular fracture, with deviation
	2A	Reducible and stable
	2B	Reducible and unstable
	2C	Irreducible
Type 3	Intra-articular fracture, without deviation
Type 4	Intra-articular fracture, with deviation
	4A	Reducible and stable
	4B	Reducible and unstable
	4C	Irreducible

OTA System

AO/ASIF classification is the widely accepted classification.
Radius is given the number 21 based on the classification.^[6]
It is further subdivided as:

OTA System
A	Extra-articular fractures
	A1	Ulnar fracture, radius intact
	A2	Radius fracture, simple and impacted
	A3	Radius fracture, multifragmentary
B	Partial articular fractures
	B1	Radius fracture, sagittal
	B2	Radius fracture, frontal, dorsal rim
	B3	Radius fracture, frontal, volar rim
C	Complete articular fractures
	C1	Articular simple + metaphyseal simple
	C2	Articular simple, metaphyseal multifragmentary
	C3	Articular multifragmentary

Types of Fractures based on Eponyms

Barton’s Fracture

Fracture-dislocation of radiocarpal joint (with intra-articular fracture involving the volar or dorsal lip)

Chauffer’s Fracture

Fracture of radial styloid

Colles’Fracture

Dorsally displaced, extra-articular fracture

Die-punch Fracture

Depressed fracture of the lunate fossa (articular surface)

Smith’s Fracture

Volar displaced, extra-articular fracture

References

↑ Frykman G (1967). “Fracture of the distal radius including sequelae–shoulder-hand-finger syndrome, disturbance in the distal radio-ulnar joint and impairment of nerve function. A clinical and experimental study”. Acta Orthop Scand: Suppl 108:3+. PMID 4175195.
↑ Melone CP (1993). “Distal radius fractures: patterns of articular fragmentation”. Orthop Clin North Am. 24 (2): 239–53. PMID 8479722.
↑ Melone CP (1984). “Articular fractures of the distal radius”. Orthop Clin North Am. 15 (2): 217–36. PMID 6728444.
↑ Fernandez DL (2001). “Distal radius fracture: the rationale of a classification”. Chir Main. 20 (6): 411–25. PMID 11778328.
↑ Cooney WP (1993). “Fractures of the distal radius. A modern treatment-based classification”. Orthop Clin North Am. 24 (2): 211–6. PMID 8479719.
↑ Arealis G, Galanopoulos I, Nikolaou VS, Lacon A, Ashwood N, Kitsis C (2014). “Does the CT improve inter- and intra-observer agreement for the AO, Fernandez and Universal classification systems for distal radius fractures?”. Injury. 45 (10): 1579–84. doi:10.1016/j.injury.2014.06.017. PMID 25042062.

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[pmid4175195-1] Frykman G (1967). “Fracture of the distal radius including sequelae–shoulder-hand-finger syndrome, disturbance in the distal radio-ulnar joint and impairment of nerve function. A clinical and experimental study”. Acta Orthop Scand: Suppl 108:3+. PMID 4175195.

[pmid8479722-2] Melone CP (1993). “Distal radius fractures: patterns of articular fragmentation”. Orthop Clin North Am. 24 (2): 239–53. PMID 8479722.

[pmid6728444-3] Melone CP (1984). “Articular fractures of the distal radius”. Orthop Clin North Am. 15 (2): 217–36. PMID 6728444.

[pmid11778328-4] Fernandez DL (2001). “Distal radius fracture: the rationale of a classification”. Chir Main. 20 (6): 411–25. PMID 11778328.

[pmid8479719-5] Cooney WP (1993). “Fractures of the distal radius. A modern treatment-based classification”. Orthop Clin North Am. 24 (2): 211–6. PMID 8479719.

[pmid25042062-6] Arealis G, Galanopoulos I, Nikolaou VS, Lacon A, Ashwood N, Kitsis C (2014). “Does the CT improve inter- and intra-observer agreement for the AO, Fernandez and Universal classification systems for distal radius fractures?”. Injury. 45 (10): 1579–84. doi:10.1016/j.injury.2014.06.017. PMID 25042062.

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