Received date: May 10, 2016; Accepted date: May 11, 2016; Published date: May 17, 2016
Citation: Leonid Solomin,Theodor Slongo Long Bone Defect Classification: What It Should Be? Bone Rep Recommendations. 2016, 2:1. DOI: 10.4172/2469-6684.100016
Copyright: © 2016 Solomin L, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License,which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
Long bone defects; Classification
Dr. Maurice E. Muller said that classification is useful only if it considers the severity of the bone lesion and serves as a basis for treatment and for evaluation of the results. Very useful and practical Muller-AO of long-bone fractures classification was developed on this principle . Unfortunately, the Developed in Ilizarov Kurgan Center classification are intended only for use of the Ilizarov method [2-4]. The other group of classifications [5-9] designed to determine the optimal option of revision arthroplasty.
To develop universal classification of long bone defects.
The principles of Muller-AO of long-bone fractures classification were used: from simple to complex, with an alphanumeric designation of a particular type of pathology.
The defects of each bone segment are divided into four types and with further subdivision into three groups and their subgroups generating a hierarchical organization in triads (Figure 1).
A - Limited defects (<20%)
A1 - Diaphyseal
A2 - Metaphyseal
A3 - Epyphiseal
B - Bone fragments have contact
B1 - Full contact with the anatomical shortening
B2 - Limited contact without anatomical shortening
B3 - Limited contact with anatomic shortening
C - Bone fragments have no contact (segmental defects, “defect-diastase”)
C1 - Segmental defects without shortening
C2 - Segmental defects with shortening
C3 - Subtotal defects
D - Complete articular defects
D1 - Epiphyseal
D2 - Epimethaphyseal
D3 - Epimethadiaphyseal
D4 - Amputation
Like in Muller-AO fractures classification numerical designation of bones and segments are used (Figure 2). In angular deformity true shortening (defect) should be determined after modeling deformity correction. Bone defects can be associated with soft-tissue defect, infectious process,neuro-vascular disorders, deformation of the segment, devitalisation of bone fragments, etc. In these cases additional appropriate classifications, including developed by the AO, should be used.
The proposed classification allows identifying priority treatment methods. For example, for "A" different kinds of free bone grafting, dependent on degree of pathology. For "B" free and vascularized grafting. For "C" a variety of Ilizarov techniques. For "D" arthroplasty and prosthetics. Undoubtedly, the development of methods bone defect treatment will require improving classification that has been happening with the Muller-AO fractures classification.
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