CLASSIFICATION SYSTEMS

OPEN FRACTURES – GUSTILLO AND ANDERSON

Type I – Wound <1cm long, little ST damage, no sign of
crush, simple/transverse/oblique fx w/ little comminution
Type II – Wound >1cm long, minor ST damage,
slight/moderate crush injury, moderate comminution
Type III – Extensive ST injury, high degree of comminution
IIIa – ST coverage of bone is adequate, trauma high-energy
IIIb – extensive ST damage requiring free-flap for coverage, assoc w/
periosteal stripping and ST contamination Type IV – Intraarticular comminuted fx
IIIc – any open fx w/ arterial injury requiring immediate repair Type V – (peds) Extraarticular fx through epiphysis

CLOSED FRACTURES – ROCKWOOD AND GREEN

Type I – Direct Trauma; closed fx by a direct blow Type I Type II Type III Type IV Type V
A – Tapping Fx; low velocity blow, little comminution and little ST TORG CLASSIFICATION
damage
B – Crush Fx; high velocity blow, extensive ST injury & comminution
Type I – Acute Jones fx
Type II – Indirect Trauma; closed fx from force acting Type II – Delayed-union Jones or diaphyseal stress fx
distant to the fx site Type III – Non-union Jones or diaphyseal stress fx
A – Traction Fx; transverse avulsion fx at site of tendon or ligament CHAPMAN CLASSIFICATION
B – Angulation Fx; transverse fx caused by bending of long bone Type Ia – Non-displaced Jones fx
C – Spiral Fx; oblique fx 45° from axis of long bone, by rotational force Type Ib – Displaced or comminuted Jones fx
D – Compression Fx; impaction of shaft into soft cancellous bone
E – Angulation and Axial Compression Fx; transverse fx w/ butterfly Type II – Delayed or non-union Jones fx
fragment Type IIIa – Non-articular styloid process fx
F – Angulation and Rotation Fx; causes oblique fx lines Type IIIb – Articular styloid process fx

FRACTURE STABILITY – CHARNLEY NAVICULAR FRACTURES – WATSON/JONES

Most Stable – transverse fx CLASSIFICATION
Potentially Stable – short obliqe fx, <45° from transverse Type I – Avulsion fx off tuberosity by PT tendon
Least Stable – long oblique, >45°, comminuted fxs Type II – Dorsal lip fx, may resemble os supranaviculare
Type IIIa – Transverse fx, non-displaced
NON-UNIONS – WEBER & CECH Type IIIb – Transverse fx, displaced
Hypertrophic Type Type IV – Stress fx
(vascular, reactive)
1. Elephant’s foot LISFRANC’S FRACTURES – HARDCASTLE CLASSIFICATION
2. Horse’s hoof Type A – either homolateral (metatarsals displaced laterally)
3. Oligotrophic or homomedial (metatarsals displaced medially.)
Type B – Partial incongruity; not all metatarsals are displaced
in the same direction.
Atrophic Type Type C – Divergent; 1st metatarsal is medially dislocated, 2-5
(avascular, non-reactive) are either partially or completely laterally dislocated.
1. Torsion wedge
2. Comminuted
3. Defect
4. Atrophic

1ST MPJ DISLOCATIONS – JAHSS CLASSIFICATION

Type I – Hallux/sesamoid dislocation, no disruption of
sesamoid apparatus, irreducible to closed reduction.
Type IIa – closed reducible, disrupted intersesamoidal
ligament
Type IIb – closed reducible, transverse fx of sesamoids
Type IIc – open reduction, both IIa and IIb.

5TH METATARSAL BASE FRACTURES – STEWART CLASSIFICATION

Type I – “Jones Fracture,” transverse fx of diaphyseal /
metaphyseal junction. Healing potential is poor.
Type II – Intraarticular avulsion fx
Type III – Extraarticular avulsion fx
 superior surface of the calcaneus; some cortex still intact.
Occurs when heel strikes ground w/ knee extended and foot
dorsiflexed. View w/ lateral foot radiograph.
Type IIb – avulsion fx of the tendo Achilles, same as a IIa but
with complete dislocation.

Type IIIa – simple fx, oblique through calcaneal body not

involving the STJ. Occurs secondary to a fall, landing on both
heels w/ the feet inverted or everted. View w/ lateral foot,
axial calcaneal.
Type IIIb – same as IIIa, but comminuted.

QUENU & KUSS

CLASSIFICATION
Type A – Homolateral/partial incongruity of Lisfranc’s joint Type IVa&b – same as type III, but w/ STJ involvement.
Type B – Isolateral/partial incongruity or Lisfranc’s joint
Type C – Divergent fx; dislocation of Lisfranc’s joint
CALCANEAL FRACTURES
Signs & Symptoms: Acute pain, edema about heel, pain w/
compression/palpation, pain w/ STJ motion, fx blisters on
skin, plantar medial&lateral ecchymosis (mondur’s sign)
Bohler’s Angle: Measures sagittal plane relationship of talus
and calcaneus – compare to contralateral side.
Normal = 25 -40 degrees; fx lowers or reduces this angle
Critial Angle of Gissane: Measure of calcaneal strut that
supports the lateral talar process. Type Va – intraarticular STJ fx w/ comminution and
Normal = 130 degrees; intraarticular fx will decrease depression of the articular segment.
Broden View: Lateral oblique projection to visualize the Type Vb – intraarticular fx of the calcaneo-cuboid joint.
posterior facet and a medial oblique to view the sinus tarsi.
Isherwood View: Lateral oblique axial to visualize posterior
facet, medial oblique axial to visualize middle articular facet,
and lateral oblique to visualize anterior process.
ROWE CLASSIFICATION
Type Ia – plantar calcaneal tuberosity fx,
secondary to eversion force (medial
tuberosity) or inversion (lateral tuberosity.)
View w/ axial calcaneal, lateral foot.
Type Ib – shearing fx of ESSEX-LOPRESTI CLASSIFICATION
the sustentaculum tali, Type Ia – tuberosity fx; beak/medial avulsion fx,
secondary to inverted vertical/horizontal body fx. (Rowe types I and II)
landing of heel. View w/
axial calcaneal.
Type Ic – anterior process fx, may appear
similar to os calcaneum secundum. Occurs
as a bifurcate ligament avulsion, secondary
to adduction and plantarflexion. View w/
lateral, lat oblique isherwood.
Type IIa – “beak fracture,”
meaning a lift-off of the posterior
Type Ib – calcaneo-cuboid joint involvement Type III (AB, AC, and BC) – three part fx w/ central
Type IIa – undisplaced STJ fx, secondary fx line exits depressed segment.
posteriorly through calcaneus.
Type IIb – displaced STJ fx, secondary fx line exits dorsally
through calcaneus and a fragment dislocates.
Type IIc – comminuted STJ fx.

Type IV – comminuted fx of
posterior facet.
-The current standard for calcaneal
classification is the Rowe system.
For Rowe class IV and V
(intraarticular – 75% chance) then a
coronal CT scan is indicated, and the
Sanders system is typically used to
classify.
DEGAN CLASSIFICATION
Type I – Non-displaced fx of anterior process
Type II – Displaced fx of anterior process, extra-articular
Type III – Displaced fx of anterior process, articular
HANNOVER CLASSIFICATION
WATSON-JONES CLASSIFICATION CT evaluation of fragmentation – 5 general fragments
1. Sustentaculum 2. Tuberosity 3. STJ 4. Anterior process
Not involving the STJ 5. Anterior STJ fragment
Type A – vertical fracture of tuberosity
Type B – horizontal fracture of tuberosity TALAR NECK FRACTURES – HAWKIN’S CLASSIFICATION
Type C – fracture of sustentaculum tali These fxs are usually seen in MVAs or short-height falls
Type D – fracture of the anterior process Type I – minimal displacement, 7-15% chance of AVN
Involving the STJ Type II – STJ subluxation, 35-50% chance of AVN
Type A – undisplaced fracture through body Type III – ankle dislocation, 85% chance of AVN
Type B – displaced fracture through body Type IV – STJ/ankle/TNJ dislocation, 100% chance of AVN
Type C – fracture w/ comminution and displacement of STJ Hawkin’s Sign – subchondral lucency of the body of the talus
following fx; appears 6-8 weeks post fx; = revascularization
SANDER’S CLASSIFICATION
(Note: This classification system
requires the fracture to be visualized
w/ coronal CT scan.)
Type I (A, B, and C) – nondisplaced
articular fx.
Type II (A, B, and C) – two part fx
of posterior facet.

TALAR DOME LESIONS – BERNDT-HARDY CLASSIFICATION

Stage I – small area of compression in subchondral bone.
Stage II – partially detached osteochondral fragment.
Stage III – completely detached fragment, in crater.
Stage IV – complete fx, out of crater. Poor prognosis. Ic – fx w/ ankle & STJ displacement Id – fx w/ total displacement
Type II – Horizontal shear fracture
IIa – Non-displaced IIb - displaced
FRACTURES OF THE LATERAL PROCESS OF THE TALUS -
FJELDBORG
Type I – Incomplete fx (no ORIF necessary)
Type II – Fx w/ displacement (ORIF)
Type III – Fracture w/ STJ dislocation (ORIF)
HAWKIN’S CLASSIFICATION
Type I – Simple fx from AJ articulation to STJ
Type II – Comminuted fx involving calcaneal & fibular
articulations
Type III – Chip fx of anterior/inferior portion of lat process
SHEPHERD’S FRACTURES – DOBAS & WATSON
Stage I – Normal lateral tubercle, no clinical significance
Stage II – Enlarged lateral tubercle
Stage III – Non-fused os trigonum
Stage IV – Synchondratic union of os trigonum to talus
EPIPHYSEAL FRACTURES – SALTER-HARRIS CLASSIFICATION

DIAL a PIMP denotes the location of talar dome lesions –

dorsiflexion internal rotation = anterior lateral lesion,
plantarflexion inversion = medial posterior lesion.
Medial Lesions: (PIMP, 56%) Deep, cup shaped, less likely to displace.
Lateral Lesions: (DIAL, 44% ) Thin, wafer shaped, easily displaced.
MRI STAGING OF TALAR DOME FRACTURES
Stage I – injury to articular cartilage only
Stage II – cartilage injury w/ underlying fracture
IIa – w/ bone edema IIb – w/o bone edema
Stage III – detached (rim signal) but not displaced fragment
Stage IV – displaced fragment
Stage V – subchondral cyst
Type I – shearing force, separation of epiphysis from
ARTHROSCOPIC STAGING OF TALAR DOME FRACTURES
metaphysis w/o fx, seen at birth and in young children.
Stage A – Smooth, intact but soft; stable Type II – fx line extends through physis and exits metaphysis.
Stage B – Rough surface, intact; stable Shearing or avulsion force, + Thurston Holland sign.
Stage C – Fibrillation/fissuing; stable Thurston Holland Sign – triangle shaped metaphyseal fx.
Stage D – Flap present or bone exposed; unstable Type III – fx line extends through physis and exits epiphysis
Stage E – Loose, non-displaced fragment; unstable (intraarticular). Due to shearing force.
Stage F – Displaced fragment Type IV – intraarticular fx through epiphysis, physis, and
FRACTURES OF THE TALAR BODY - SNEPPEN metaphysis. Prognosis is poor.
Group I – Talar Dome Fracture/OCD (use Berndt-Hardy) Type V – compression fx, compacted germinal cells of physis
Group IIa – Shear Fracture – 50% AVN, requires ORIF die and cause premature closure. Poor prognosis.
Type 1a – non-displaced Type 1b – displacement of trochlear surface Type VI (Rang) - contusion of perichondral ring of physis,
Type 1c – displacement of trochlear surface w/ STJ dislocation
Type 1d – total dislocation of talar body acts like type V if a bony bridge develops – prognosis good.
Type 2a – displaced horizontal fx Type VII (Ogden) – epiphyseal fx not affecting physis
Type 2b – non-displaced horizontal fx Type VIII (Ogden) – partial fx of metaphysis, growth lines
Type 3a – displaced sagittal fx Type 3b - non-displaced sagittal fx
Type IX (Ogden) – degloving loss of periosteum on diaphysis
Group III – Posterior Tubercle Fracture – Shepherd’s Fx POLAND CLASSIFICATION
Group IV – Lateral Process Fracture (Fjeldborg)
Types I to III – same as salter-harris I to III
Group V – Crush injury – highly comminuted
Type IV – fx through entire physis w/ epiphyseal fx as well
BOYD & KNIGHT CLASSIFICATION
PETERSON CLASSIFICATION
Type I – Coronal or sagittal shear fracture
Ia – Non-displaced Ib – fx w/ displacement at ankle joint
Type I – Transverse fx of metaphysis w/ longitudinal The first word in this classification denotes the position of the
compression of physis foot at time of injury; the second word denotes the position of
Type II – Salter-Harris II the leg. The numerical grades w/in each class occur each in
Type III – Salter-Harris I chronological order and relate to the severity of trauma.
Type IV – Salter-Harris III Supination – Adduction
Type V – Salter-Harris IV I – transverse fx of the lateral malleolus
Type VI – Open fx w/ removal of part of the physis, as in II – vertical fx of the medial malleolus
lawnmower injury or farm equipment Pronation – Abduction
WEBER CLASSIFICATION I – Rupture of deltoid ligament/medial malleolar fx
Type A – Extra-articular II – Rupture of ant inferior tibio-fibular ligament
A1 – Separation of physis A2 – Fragmentation of epi/metaphysis III – Bending fx of fibula 1cm proximal to plafond
Type B – Intra-articular Pronation – Dorsiflexion
B1 – w/in physis, extending to epiphysis I – Fx of medial malleolus
B2 – Through epiphysis, physis, and metaphysis
II – Large anterior lip fx of tibia
DIAS-TACHDJIAN CLASSIFICATION
III – Fracture of superior lateral malleolus
Supination-Inversion – grade I (A) IV – Fracture of third malleolus (posterior tibia)
Supination-Inversion – grade II (B) Supination – External Rotation (SER)
Supination-Plantarflexion (C) I – Rupture of ant inferior tibio-fibular ligament
II – Spiral oblique fx of lateral malleolus (extending
anterior inferior to posterior superior.)
III – Rupture of post inferior tibio-fibular ligament
IV – Deltoid rupture/fx of medial malleolus
Pronation – External Rotation (PER)
I – Rupture of deltoid ligament/medial malleolar fx
II – Rupture of ant inferior tibio-fibular ligament,
Intra-osseous ligament, intra-osseous membrane
Supination-Ext Rotation – grade I (D) III – Spiral fx above syndesmosis (high fibular fx)
Supination-Ext Rotation – grade II (E) IV – Rupture of post inferior tibio-fibular ligament
Pronation-Eversion-Ext Rotation (F) This injury typically causes diastasis – separation of the tibio-
Juvenile Tillaux Fracture (G) fibular syndesmosis. This may also be seen in SER.
Triplanar Fracture (H)

EPONYMOUS ANKLE FRACTURES

Pott’s/Dupuytren’s Fracture – bimalleolar fx
Cotton’s Fracture – trimalleolar fx; medial/lateral malleoli +
posterior or anterior distal tibia.
Maisonneuve Fracture – proximal fibular fx (near head) as a Supination – Adduction Pronation-Abduction
result of torsional stress (PER).
Bosworth Fracture – mid-fibular fx w/ ankle dislocation
Tillaux-Chaput Fracture – avulsion fx of anterior inferior
lateral tibia
Wagstaffe Fracture – avulsion fx of ant inferior medial tibia
Volkmann Fracture – posterior tibial fracture
MEDIAL MALLEOLAR FRACTURE – MULLER CLASSIFCATION
Type A – Avulsion of tip of medial malleolus
Type B – Avulsion at the level of the ankle joint
Type C – Oblique fx
Type D – Vertical orientation
LATERAL MALLEOLAR FRACTURE – DANIS-WEBER CLASSIFICATION
Type A – Fracture below the level of the tibial plafond Supination-External Rotation Pronation-External Rotation
Type B – Fracture at the level of the tibial plafond
Type C – Fracture above the level of the tibial plafond
ANKLE FRACTURES – LAUGE-HANSEN CLASSIFICATION
 Pronation-Dorsiflexion
CHRONIC TIBIOFIBULAR DIASTASIS – EDWARDS & DELEE
Type I – Straight lateral subluxation of the fibula, w/ medial
clear space on x-ray, due to interposition of delroid ligament.
Type II – Lateral fibular subluxation w/ plastic or angular
deformity, due to fibular microfracture
Type III – Posterior rotatory subluxation of distal fibula
behind talus w/ PITFL intact
Type IV – Talus is dislocated superiorly, wedged between the
tibia and fibula.

CHOPART’S FRACTURES – MAIN & JOWETT

1) Medial Force (30%)  precursor to STJ dislocation
Type A - flake fx of dorsal talus or navicular and lateral
calcaneus or cuboid
Type B - medial displacement of FF w/ TN and CC joints
Type C - FF rotates medially around interosseous
talocalcaneal lig w/ TN disassociation and CCJ intact AO CLASSIFICATION (MUELLER)
2) Longitudinal Force (40%) worst prognosis of non-crush
Type A - extra articular
Type A - maximally PF ankle giving a characteristic pattern
Type B - partially articular
of through and through navicular compression fracture
Type C - completely articular
A1 - force through 1st ray: crushes medial 3rd w/ tuberosity All three can involve:
displaced medially a. no comminution or impaction in articular or metaphyseal surface
A2 - force thru 2nd ray: crushes middle 3rd w/ middle 3rd & b. impaction involving supra-articular metaphysic
tuberosity displaced medially c. comminution & impaction of articular surface with metaphyseal
impaction
A3 - force thru 3rd ray: crushes lateral 3rd w/ medial 2/3 &
tuberosity displaced medially
Type B - submaximally PF ankle resulting in dorsal
displacement of superior navicular, crush of inferior on x-ray
3) Lateral Force (17%)
Type A - FF forced into valgus w/ fx of navicular tuberosity
or dorsal talus and compression fx of CCJ (Nutcracker fx)
Type B - TNJ displaces laterally w/ comminution of CCJ
4) Plantar Force (7%)
Type A -avulsion fx of dorsal navicular or talus & ant process
Type B - impaction fracture of inferior CCJ
5) Crush Injury (6%)

PILON FRACTURES – RUEDI & ALLGOWER

CLASSIFICATION
Type 1- Mild to moderate displacement & no comminution,
w/o major disruption of ankle joint
Type 2- Moderate displacement & no comminution w/
significant dislocation of ankle joint
Type 3- Explosion fx, severe comminution & displacement

OVADIA & BEALS CLASSIFICATION

Type I - intra-articular injuries that are not displaced
Type II - minimally displaced intra-articular fractures

Type III - moderately displaced intra-articular fx w/ several

large fragments
Type IV - intra-articular w/ moderate displacement and large Group III – Severe injury; lateral ankle swelling and pain, ant
metaphyseal defects drawer +, talar tilt >15°
Group IV – Chronic problem, ant drawer +, talar tilt >15°

STJ DISLOCATION – BUCKINGHAM

Type I – Medial dislocation of STJ
Type II – Lateral dislocation of STJ
Type III – Anterior/posterior dislocation of STJ

Type V - severe comminution of PTTD – JOHNSON AND STROM

both distal tibial metaphysis and Stage I – Medial pain, tenosynovitis, mild weakness on heel-
articular surface raise test
KELLAM & WADDELL Stage II – Medial/lateral pain, tendon elongation, flexible pes
CLASSIFICATION planus, weakness on heel raise, + too many toes sign
Type A - rotational pattern consisting of 2 or more large tibial Stage III – Medial/lateral pain, tendon degeneration, fixed pes
articular fragments, minimal or no anterior comminution, and planus, no inversion on heel raise, + too many toes sign
a transverse/oblique fibular fracture at tibial plafond Stage IV – Medial/lateral pain, tendon degeneration, flexed
Type B - compressive fracture pattern w/ multiple tibial pes planus, no inversion on heel raise, + too many toes sign,
fragments w/ marked anterior tibial cortical comminution STJ arthritis
MAALE & SELIGSON CLASSIFICATION MUELLER CLASSIFICATION
Type 1 - distal tibial compression fracture Based on Etiology
Type 2 - external rotatory fx w/ large posterior fragment Type I – Direct injury
Type 3 - spiral fx from articular surface to metaphysis Type II – Rupture secondary to systemic disease
DESTOT SYSTEM Type III – Idiopathic
Subgroup I - posterior marginal fx of tibia Type IV – Rupture secondary to mechanical dysfunction
Subgroup II - anterior marginal fx of tibia
Subgroup III - explosion fx of tibia CONTI CLASSIFICATION (MRI)
Subgroup IV - supra-articular fx w/ extension into ankle joint Stage I – One or two fine, longitudinal tears
MAST SYSTEM Stage II – Intramural degeneration, variable diameter, wide
Type 1 - malleolar fx w/ significant axial load at time of longitudinal tears
injury producing large posterior fragment Stage III – Scarring in tendon, complete tear
Type 2 - spiral extension fx ROSENBERG CLASSIFICATION (MRI)
Type 3 - central compressive injury divided into A,B,C Stage I – Hypertrophic tears in tendon (appears bulbous)
Stage II – Atrophic tears
ANKLE SPRAINS – DIAS CLASSIFICATION Stage III – Complete tear
Grade I – partial rupture of CFL
Grade II – complete rupture of ATFL ACHILLES RUPTURE – KUWADA CLASSIFICATION
Grade III – complete rupture of ATFL, CFL, and/or PTFL Type I – Partial rupture of tendon
Grade IV – complete rupture of all 3 lateral ligaments + Type II – Complete rupture of tendon, <3cm gap
partial rupture of deltoid ligament Type III – Complete rupture, 3-6cm gap
O’DONOGHUE CLASSIFICATION Type IV – Complete rupture, >6cm gap
1st Degree – ligament stretch w/ minimal disruption
2nd Degree – partial ligament disruption w/ joint instability TENDO-ACHILLES RADIOPAQUE LESIONS
3rd Degree – complete ligament disruption MORRIS, GIACOPELLI, AND GRANOFF CLASSIFICATION
LEACH CLASSIFICATION Type I – Radioopacities found in the Achilles insertion –
1st Degree – partial or complete tear of ATFL lesion is w/in tendon but attached to calcaneus
2nd Degree – partial or complete tear of ATFL & CFL Type II – Intratendinous opacities seen at the insertion 1-3cm
3rd Degree – partial or complete tear or ATFL, CFL, & PTFL proximal to bone. Lesions are clearly separated from
RASMUSSEN CLASSIFICATION calcaneus, typically involving only partial thickness of tendon
Stage I – rupture of ATFL Type III – Lesions occur proximal to the insertion up to 4-
Stage II – rupture of superficial fibers of PTFL 12cm from attachment, w/o calcaneal involvement.
Stage III – rupture of CFL Type IV – Partial tendon ossification or calcification
Stage IV – rupture of deep fibers of PTFL Type V – Total tendon involvement
HENRY CLASSIFICATION
Group I – POP tender over ATFL, ant drawer -, talar tilt <5° PERONEAL TENDON DISLOCATION - ECKERT & DAVIS
Group II – Moderate injury; POP over ATFL & CFL, ant Grade I – retinaculum ruptured from cartilaginous lip to
drawer -, talar tilt <15° posterior lateral malleolus
Grade II – distal 1-2cm fibrous lip of malleolus is elevated w/ Type I – Hematogenous osteo
retinaculum Type II – Osteo secondary to contiguous source
Grade III – a thin fragment of bone w/ cartilage is avulsed Type III – Osteo assoc w/ vascular insufficiency
from deep surface of peroneal retinaculum & deep fascia Type IV – Chronic osteo
PATZAKIS CLASSIFICATION
Zone I – Distal metatarsal neck (most common)
Zone II – MT neck to MTJ (least common)
Zone III – calcaneus or talus

TARSAL COALITIONS – DOWNEY

A. Juvenile (Osseous Immaturity)
Type I – extra-articular coalition
SHOTGUN WOUNDS – SHERMAN AND PARRISH Ia – no secondary arthritis, tx w/ badgley procedure
Type I – Penetrates sub-Q or deep fascia, from distance Ib – secondary arthritis, tx w/ resection, triple arthrodesis
greater than 7 yards Type II – intra-articular coalition
IIa – no secondary arthritis, tx w/ resection or triple arthrodesis
Type II – Occurs at 3-7 yards, violating bone, viscera, and IIb – secondary arthritis, tx w/ triple arthrodesis
vascular system B. Adult (Osseous Maturity)
Type III – Occurs at <3 yards, blast injury w/ severe local Type I – extra-articular coalition
destruction of all tissues Ia – no secondary arthritis, tx w/ resection or triple arthrodesis
ORDOG CLASSIFICATION Ib – secondary arthritis, tx w/ triple arthrodesis
Type 0 – No injury (suspicion of injury, due to blood spatter) Type II – intra-articular coalition
IIa – no secondary arthritis, tx w/ triple or isolated arthrodesis
Type I – Blunt injury (non-penetrating due to vest, shoe, etc.) IIb – secondary arthritis, tx w/ triple arthrodesis
Type II – Graze injury (abrasion, injury to superficial dermis) PERLMAN AND WERTHEIMER CLASSIFICATION
Type III – Blast effect w/o missile penetration (near miss) Type I – Congenital coalition Type II – Acquired coalition
Type IV – Blast effect w/ missile penetration TACHDJIAN CLASSIFICATION
Type V – Penetrating injury
A – Laceration of dermis B – Sub-Q C – Deep Tissues I. Isloated Anomaly
D – Body cavity E – More than one body region Ia – TC, CN, CC, or NC Ib – multiple combinations of Ia
Ic – massive tarsal coalition
Type VI – Perforating/through & through (A-E above)
II. Part of Complex Malformation
Type VII – Penetration w/ missile embolization IIa – assoc w/ other synostoses (carpal coalition, synphalangism)
IIb – manifestation of a syndrome (Apert’s, Nievergelt-Perlman)
PUNCTURE WOUNDS – GREEN & BRUNO III. Associated w/ Major Limb Abnormalities
Type I – Early dx w/ surgical I&D and appropriate antibiotic POLYDACTYLY – VENN & WATSON
coverage, resulting in complete healing w/ no sequelae A. Wide Metatarsal Head
Type II – Delay in dx of 9-14 days. Surgical I&D w/ abx will B. T-shaped Metatarsal Head
eradicate infection, possibly w/ residual bone, joint deformity C. Y-shaped Metatarsal Head
Type III – Delay in dx more than 2 weeks, resulting in D. Digital Duplication
chronic infection, necessitates bone resection E. Complete Duplication
TETAMY & MCKUSICK
OSTEOMYELITIS – BUCKHOLZ CLASSIFICATION
Type I – wound induced osteomyelitis Post-axial polydactyly only
Ia – open fx w/ complete discontinuity Ib – penetrating wound Type A – Complete digit that articulates
Ic – post-op infection
w/ 5th MT head or duplicate 5th MT
Type II – mechanogenic infection
IIa – implants, internal fixation Type B – Accessory digit w/o osseous attachment
IIb – contact instability/bone on bone apposition BLAUTH & OLASON CLASSIFICATION
Type III – physeal osteomyelitis Type A – Arrangement based on duplication distal to prox
Type IV – ischemic limb disease A1 – distal phalanx A2 – middle phalanx
Type V – combination osteo of types I-IV A3 – proximal phalanx A4 – metatarsal A5 – tarsal bone
Type VI – osteitis from septic arthritis Type B – Transverse numbering of digits medial to lateral
Type VII – chronic osteomyelitis SYNDACTYLY – DAVIS & GERMAN
CIERNY-MADER CLASSIFICATION Type I – incomplete webbing between digits
Type I – medullary osteo Type II – complete webbing to ends of digits
Type II – superficial osteo Type III – simple syndactyly, no phalangeal involvement
Type III – localized osteo Type IV – complicated, phalangeal bones appear abnormal
Type IV – diffuse osteo
Type A – good immune system and vascularity CHARCOT FOOT – EICHENHOLTZ
Type B – local or systemic immune compromise Stage I – destructive phase w/ joint laxity, subluxation, and
Type C – tx will be more harmful to patient than disease osteochondral fragmentation
WALDVOGEL CLASSIFICATION
Stage II – coalescence; absorption of debris and fusion of AVN OF THE 2ND METATARSAL – FREIBERG
larger fragments to adjacent bone Type I – no DJD, articular cartilage intact
Stage III – remodeling; revascularization and remodeling of Type II – periarticular spurs, articular cartilage intact
bone and fragments Type III – severe DJD, loss of articular cartilage
Type IV – epiphyseal dysplasia, multiple head involvement
ANTERIOR TIBIOTALAR SPURS – MCDERMOTT & SCRANTON AVN OF TH 2ND METATARSAL – KATCHERIAN
Type I – Synovial impingement. X-rays show inflammatory Level A – fissures noted in distal metaphysis or epiphysis
reaction, up to 3mm spur formation, confirmed w/ DF stress Level B – increased fissuring w/ bone resorbtion
views. Increased anterior ST swelling. Level C – increased fissuring w/ central collapse of MT head
Type II – Osteochondral reaction exostosis. X-rays show Level D – collapse & fx w/ fragments on either side of joint
osseous spur formation >3mm. MRI confirms osteoblastic and Level E – complete collapse of MT head
chondral hyperplastic reaction.
Type III – Significant exostosis w/ or w/o fragmentation, 2° COMPLEX REGIONAL PAIN SYNDROME CLASSIFICATION
spur formation on the talus w/ fragments, osteophytes. A.K.A. REFLEX SYMPATHETIC DYSTROPHY
Type IV – Pan-talocrural arthritic destruction. X-rays suggest Stage I – ST edema, redness, heat, pronounced pain w/
medial, lateral, or posterior degenerative, arthritic changes. guarding, reluctant movement, hyperesthesia to light touch,
hyperhidrosis, after 3-4wks see spotty osteoporosis on X-ray.
HALLUX LIMITUS/RIGIDUS – DRAGO, ORLOFF, AND JACOBS Stage II – (approx 3mos); brawny edema, joint fibrosis,
Grade I – Functional limitus severe spotty osteoporosis (Sudek’s atrophy), cyanotic skin
Hallux equinus/flexus, plantar subluxation of proximal phalanx, MPE, no
DJD, hyperextension of HIPJ, pronatory architecture, joint ROM normal
Stage III – 6-9 mos; cool, dry, tight-appearing and wax-like
NWB, but is limited on WB. skin, diffuse osteoporosis, joint stiffness, disability
Grade II – Adaptation; proliferative/destructive joint change
Flattening of 1st MT head, pain on end ROM, passive ROM limited, NERVE INJURY – SEDDEN
osteochondral defect/cartilage fibrillation & erosion, small dorsal exostosis, Neuropraxia – interruption of nerve impulse due to extrinsic
subchondral eburnation, periarticular lipping or phalanx base and 1st MT head
pressure, resulting in pinpoint segmental demyelination
Grade III- Joint deterioration/arthritis, established arthrosis Axonotmesis – severance of individual nerve fibers, resulting
Severe flattening of 1st MT head, osteophytosis dorsally, non-uniform
narrowing of joint space, degeneration of articular cartilage, erosions, in partial severance of nerve
creptius, subchondral cysts, pain on ROM, assoc inflammatory arthritis Neurotmesis – complete severance of nerve, resulting in
Grade IV – Ankylosis/Hallux Rigidus wallerian degeneration
Obliteration of joint space w/ loss of majority of articular surface, exuberant SUNDERLAND CLASSIFICATION
osteophytosis w/ joint mice, less than 10° ROM, deformity, malalignment
1st Degree – disruption of nerve impulses w/o wallerian
REGNAULD CLASSIFICATION
degeneration
1st Degree – Limitation of 1st MPJ ROM to 40°, pain at end
2nd Degree – disruption of axon, w/ wallerian degeneration
ROM, narrowing of joint space, flattening of MT head,
distal to the point of injury
periarticular spurring, no sesamoidal dz
3rd Degree – fibrosis of nerve, regrowth w/ fusiform swelling
2nd Degree – Arthrosis, enlargement of joint, loss of ROM,
4th Degree – incomplete severance of nerve
painful ROM, crepitus, narrowing of joint space, flattening of
5th Degree - complete severance of nerve
MT head, periarticular spurring, sesamoid hypertrophy
FOOT ULCERATION – WAGNER
3rd Degree – Ankylosis, crepitus, little or no ROM, pain, loss
of joint space, marked hypertrophy of joint, joint mice, Grade 0 – Skin is intact, no open lesions.
marked involvement of sesamoids Grade 1 – Skin only lesion, large or small, dirty or clean
MODIFIED REGNAULD/ORLOFF CLASSIFICATION Grade 2 – Deeper lesion involving tendon, muscle, or bone
Grade 3 – Grade 2 w/ infection (abscess, osteomyelitis)
Stage I – Functional hallux limitus
No DJD, no pain on end ROM, limited ROM on WB but normal NWB Grade 4 – Partial gangrene in the forefoot
Stage II – Joint adaptation Grade 5 – Entire foot is gangrenous, no procedures possible
Pain on end ROM, flattening of 1st MT head, small dorsal osteophyte
Stage III – Joint deterioration UTSA CLASSIFICATION
Crepitus on ROM, non-uniform joint space narrowing, subchondral sclerosis Grade 0 – pre or post ulcerative lesion, epithelialized
and cyst formation, osteophytosis, severe flatting of 1st MT head
Grade 1 – superficial wound, not involving tendon, capsule or
Stage IV – Ankylosis
Obliteration of joint space, osteophyte fragmentation, minimal to no ROM
bone
HANFT CLASSIFICATION Grade 2 – wound penetrating to capsule, tendon, or bone
Grade 3 – wound penetrating to bone or joint
Grade I – MPE, mild dorsal exostosis, 1st MPJ sclerosis
Type A – Clean, vascular wound
Grade IIa –Grade I +; flattening of MT head, joint space
Type B – Infected, vascular wound
narrowing, dorsal & lateral osteophytes
Type C – Clean, ischemic wound
Grade IIb – Grade IIa + subchondral sclerosis & cysts
Type D – Infected, ischemic wound
Grade III – Grade IIa + severe 1st MT head flattening,
MEADE & MUELLER CLASSIFICATION
sesamoid hypertrophy
Grade IV – Grade III + subchondral sclerosis & cysts Type 1 – Dorsal foot phlegmon (non-localized cellulitis)
Type 2 – Deep plantar space infection
Type 3 – Mal perforans diabetic foot ulcer J Bone Joint Surg Am. 1976 Jun;58(4):453-8
Closed Fractures – Rockwood & Green
Rockwood & Green’s Fractures in Adults, 6th Ed., Lippincott, 2005
BURN CLASSIFICATION Fracture Stability – Charnley
The Closed Treatment of Common Ankle Fractures, 4th Ed, Greenwich Medical
1st Degree – superficial, involving outer layer of skin, Media, 2002
erythema, no blisters Non-Unions – Weber & Cech
Weber BG, Cech O. Pseudarthrosis; Grune and Stratton, 1976
2nd Degree – superficial or deep, may or may not have blisters 1st MPJ Dislocation – Jahss
assoc w/ erythema, anesthetic Jahss MH: Foot Ankle 1980;1:15-21
5th Metatarsal Fractures – Stewart
3rd Degree – full-thickness destruction of skin, can extend to Stewart I. Jones’ fracture: fracture of the base of the fifth metatarsal. Clin Orthop
bone and is anesthetic. Includes electric burns, radiation 1960; 16:190-198
th
5 Metatarsal Fractures – Torg
burns, and frostbite. Can lead to physeal growth arrest. Torg J. Fractures of the base of the fifth metatarsal distal to the tuberosity.
Orthopedics 1990; 13:731-737
MALIGNANT MELANOMA – CLARK
th
5 Metatarsal Fractures – Chapman (?)
Navicular Fractures – Watson-Jones
Level 1 – epidermis to dermal/epidermal junction Watson-Jones R: Fractures and Joint Injuries. Vol 2. 4th ed. Baltimore, Md:
Level 2 – papillary dermis Williams & Wilkins; 1955
Lisfranc’s Fractures – Hardcastle
Level 3 – to reticular dermis Hardcastle PH, et al. Injuries to the tarsometatarsal joint. Incidence,
Level 4 – reticular dermis Classification and Treatment.. J Bone and Joint Surg 1982; 64B(3):349-56.
Lisfranc’s Fractures – Quenu & Kuss
Level 5 – subcutaneous fat Quenu. E, Kuss G. Etude Sur les luxations du metatarse. Reb Chir 39: 281, 1909.
Calcaneal Fractures – Rowe
Rowe CR, Sakellarides H, Freeman P: Fractures of os calcis - a long-term follow-
up study one hundred forty-six patients. JAMA 1963; 184: 920-923
Calcaneal Fractures – Essex-Lopresti
Essex-Lopresti P: The mechanism, reduction technique, and results in fractures of
the os calcis, 1951-52. Clin Orthop 1993 May; 3-16
Calcaneal Fractures – Watson-Jones
Watson-Jones R: Fractures and Joint Injuries. Vol 2. 4th ed. Baltimore, Md:
Williams & Wilkins; 1955
Calcaneal Fractures – Sanders
Sanders R, Fortin P, DiPasquale T: Operative treatment in 120 displaced
intraarticular calcaneal fractures. Results using a prognostic computed
tomography scan classification. Clin Orthop 1993 May; 87-95
Calcaneal Fractures – Degan
Degan TJ, Morrey BF, Braun DP: Surgical excision for anterior-process fractures
BRESLOW’S CLASSIFICATION (SURVIVIAL RATES) of the calcaneus. J Bone Joint Surg Am 1982 Apr; 64(4): 519-24
Calcaneal Fractures – Hannover
Level 1 - <0.75mm 83-100% Zwipp, H. and Tscherne, H. et al., Osteosynthesis dislozierter intraartikularer
Level 2 – 0.76-1.5mm 37-90% calcaneusfrakturen. Unfallchirurg, 1988, 91, 507-515
Talar Neck Fractures – Hawkins
Level 3 – 1.51-2.25mm 37-83% Hawkins L: Fractures of the neck of the talus.   JBJS 1970;52A:991-1002
Level 4 – 2.26-3.0mm 44-72% Talar Dome Lesions – Berndt Hardy
Berndt, A.L. & Harty, M.: Transchondral fractures of the talus. J Bone Joint Surg
Level 5 - >3mm 9-55% [Am] 41: 988-1020, 1959
Arthroscopic Classification of Talar Dome Lesions (?)
MRI Classification of Talar Dome Lesions (?)
NAIL INJURIES – ROSENTHAL Fracture of the Body of the Talus – Sneppen
Zone 1 – to distal phalanx Sneppen O, Chrstensen SB, Krogsoe O, et al: Fractures of the body of the talus.
Tx: w/o bony exposure, let granulate if <1cm, graft if >1cm injury Acta Orthop Scand 48: 317-324, 1977
If bony exposure, treat as zone 2 injury Fracture of the Body of the Talus – Boyd & Knight
Boyd HB and Knight RA : Fracture of the astragalus. Am Surg, 45-A:51-68, 1963
Zone 2 – distal to lunula Fracture of the Lateral Process of the Talus – Fjeldborg
Stasoy/Kutler pedicle flaps after wound is clean Fjeldborg O: Fracture of the lateral process of the talus, supination-dorsal flexion
Zone 3 – proximal to lunula fracture. Acta Oethorp Scand 39: 407-412, 1968
Fracture of the Lateral Process of the Talus – Hawkins
Amputation of distal phalanx (including DIPJ) Hawkins LG: Fractures of the lateral process of the talus. J Bone Joint Surg 1965;
47A: 1170-1175
Shepherd’s Fracture – Dobas & Watson
Arch. Pod. Med. Foot Surg. 3:17, 1976
Epiphyseal Fractures – Salter-Harris
RB Salter, WR Harris Injuries involving the eiphyseal plate. JBJS Vol 45. 1963. p
587-632
Epiphyseal Fractures – Poland
Poland J: Traumatic separation of the epiphyses in general. Clin Orthop 1985;
41: 7-18
MALAY CLASSIFICATION Epiphyseal Fractures – Peterson
Peterson HA: Physeal & apophyseal injuries. In: Rockwood CA, Wilkins KE,
1. Primary onycholysis Beaty JH. Fractures in Children. 4th ed. Lippincott-Raven; 1996
2. Subungual hematoma Epiphyseal Fractures – Weber
Weber, BG. Epiphyseal Joint Injuries. Helv Chir Acta. 1964 Jan;31:103-18
3. Simple nail bed laceration Epiphyseal Fractures – Dias Tachdjian
4. Complex (stellate) nail bed laceration Dias LS, Tachdjian MO: Physeal injuries of the ankle in children. Clin Orthop
Relat Res 1978;136:230–233
5. Nail bed laceration w/ phalangeal fx Medial Malleolar Fracture – Muller
6. Nail bed and toe tip loss, including nail bed avulsion, Muller M, Allgower M, Scheider R, Willenegger H. Manual of Internal Fixation.
partial digital amputation, and digital degloving 3rd Ed. Springer-Verlag, 1991.
Lateral Malleolar Fracture – Danis-Weber
Danis R. Les fractures malleolaires. In: Danis R (ed): Theorie et practique de
BIBLIOGRAPHY l'osteosynthese. Paris, Masson et Cie, 1949, pp133-165
Weber BG. Die Verletzungen des oberen Sprunggelenkes, ed 2. Bern, Stuttgart,
Open Fractures – Gustillo & Anderson
Wien, Verlag Hans Huber, 1972
Ankle Fracture – Lauge-Hansen Downey, MS: Tarsal coalitions: a surgical classification. J Am Podiatr Med Assoc
Lauge-Hansen N. Fractures of the ankle. II Combined experimental-surgical and 81:187-197, 1991
experimental-roentgenologic investigations. Arch Surg 1950; 60:957-85 Tarsal Coalitions – Perlman & Wertheimer
Chronic Tibio-fibular Diastasis – Edwards & Delee Perlman MD, Wertheimer SJ: Tarsal coalitions. J Foot Surg 1986; 25(1): 58-67
Edwards S, DeLee C. Ankle diastasis without fracture. Foot Ankle 1984;4:305-12 Tarsal Coalitions – Tachdjian
Chop art’s Fractures – Main & Jowett Stoskopf CA,et al. Evaluation of tarsal coalition by computed tomography. J
Main BJ, Jowett RL. Injuries of the midtarsal joint. J Bone Joint Surg Br. 1975 Pediatr Orthop 1984;4:365-9
Feb;57(1):89-97 Polydactyly –Venn-Watson
Pilon Fractures – Reudi Allgower Venn-Watson EA: Problems in polydactyly of the foot. Orthop Clin North Am 1976
Ruedi T, Allgower M. Fractures of the lower end of the tibia into the ankle joint. Oct; 7(4): 909-27
Injury, 1969; 1: 92-99. Polydactyly – Tetamy & McKusick
Pilon Fractures – Muller/AO Tetamy Sa, McKusick VA: Synopsis of hand malformations with particular
Muller ME, Nazarian S, KochP, et al.; Springer-Verlag, Berlin. Classification AO emphasis on genetic factors. Birth Defects 5(3):125, 1969
des fractures. 1990 Polydactyly – Blauth & Olason
Pilon Fractures – Ovadia & Beals Blauth W., Olason AT Classification of polydactyly of the. hands and feet. Arch.
Ovadia DN and Beals RK J Bone Joint Surg, 68- A:543-551, 1986 Orthop. Trauma. Surg., 1988, 107,. 334-344
Pilon Fractures – Kellam & Waddell Syndactyly – Davis & German
Kellam JF, Waddell JP. Fractures of the distal tibial metaphysis with intra- Davis JS, German WJ (1930) Syndactylism. Arch Surg 21 : 32-. 75. 5
articular extension - the distal tibial explosion fracture. J. Trauma, 1979; 19: Charcot – Eichenholz
593-601. Eichenholz SN. Charcot Joints. Springfield: Charles C. Thomas, 1966.
Pilon Fractrues – Malle & Seligson Anterior Tibiotalar Spurring – McDermott & Scranton
Maale G, Seligson D. Fractures through the distal weight-bearing surface of the Scranton PE Jr, McDermott JE. Anterior tibiotalar spurs: a comparison of open
tibia. Orthopedics. 1980: 517-521 versus arthroscopic debridement. Foot Ankle. 1992 Mar-Apr;13(3):125-9
Pilon Fractures – Destot Hallux Limitus – Drago, Oloff, and Jacobs
Destot E: Traumatismes du Pied et Rayons X. Paris, Masson et Cie, 1911 Drago JJ, Oloff L, Jacobs AM: A comprehensive review of hallux limitus. J Foot
Pilon Fractures – Mast Surg 23: 213, 1984
Mast JW, et al. Fractures of the tibial pilon. Clin Orthop, 1988; 230: 68-82. Hallux Limitus – Regnauld
Ankle Sprains – Dias Regnauld B. Hallux rigidus. In The Foot, pp 345-359, edited by B Regnauld,
Dias LS. The lateral ankle sprain: an experimental study. J Trauma Springer-Verlag, Berlin, 1986
1979;19(4):266-9 Hallux Limitus – Modified Regnauld
Ankle Sprains – O’Donoghue Vanore JV et al. Clinical Practice Guideline First Metatarsophalangeal Joint
O'Donoghue DH: Treatment of Injuries to Athletes. 2nd ed. Philadelphia, Pa: WB Disorders Panel. Diagnosis and treatment of first metatarsophalangeal joint
Saunders Co; 1970 disorders. Section 2: hallux rigidus. J Foot Ankle Surg 42:124-136, 2003
Ankle Sprains – Leach Hallux Limitus – Hanft
Leach RE, Naiki O, Paul GR, Stockel J. Secondary reconstruction Hanft, JR, Mason, ET, Landsman, AS, Kashuk, KB, A new radiographic
of the lateral ligaments of the ankle. Clin Orthop 1982; 226:169-73 classification of hallux limitus. J. of Foot and Ankle Surgery, 32(4):397-404, 1993
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Ankle Sprains – Rasmussen 2 MT AVN – Freiberg
Rasmussen O: Stability of the ankle joint. Analysis of the function and Freiberg AH: Infraction of the second metatarsal bone, a typical injury. Surg Gyn
traumatology of the ankle ligaments. Acta Orthop Scand Suppl 1985; 211: 1-75 Ob 1914; 19: 191-163
nd
Ankle Sprains – Henry ? 2 MT AVN – Katcherian
STJ Dislocation – Buckingham Katcherian DA: Treatment of Freiberg's Disease. Orthop Clin North Am 25: 69,
Buckingham WW Jr. Subtalar dislocation of the foot. J Trauma 1973;13:753-765 1994
PTTD – Johnson & Strom CRPS/RSD
Johnson KA, Strom DE. Tibialis posterior tendon dysfunction. Clinical Rosenthal AK, Wortmann RL: Diagnosis, pathogenesis, and management of reflex
Orthopedics. 1989;239:196-206 sympathetic dystrophy syndrome. Compr Ther 1991 Jun; 17(6): 46-50
PTTD – Mueller Nerve Injury – Seddon
Mueller TJ: Acquired flatfoot secondary to tibialis posterior dysfunction: Seddon HJ: Three types of nerve injuries. Brain 1943; 66: 237
Biomechanical aspects. J. Foot Surg. 30:2, 1991 Nerve Injury – Sunderland
PTTD – Conti Sunderland S: A classification of peripheral nerve injuries producing loss of
Conti S et al. Clinical significance of MRI in pre-operative planning for function. Brain 74:491-516, 1951
reconstruction of posterior tibial tendon ruptures. Foot and Ankle 1992; 13:208 Foot Ulcers – Wagner
PTTD – Rosenberg Wagner FW Jr. The diabetic foot. Orthopedics 1987;10:163-72
Rosenberg ZS, et al: Rupture of posterior tibial tendon: CT and MR imaging with Foot Ulcers – UTSA
surgical correlation. Radiology 1988;169:229-235 Lavery LA, Armstrong DG, Harkless LB. Classification of diabetic foot wounds. J
Achilles Rupture – Kuwada Foot Ankle Surg. 1996 Nov-Dec;35(6):528-31
Kuwada GT. Diagnosis and treatment of Achilles tendon rupture. Clin Podiatr Foot Ulcers – Meade & Mueller
Med Surg 1995;12: 633-52 Meade and Mueller Med Times 96: 154-169, 1968
Achilles Tendon Radiopaque Lesions – Morris, Giacopelli, and Granoff Malignant Melanoma – Clark
Morris KL, Giacopelli JA, Granoff D: Classifications of radiopaque lesions of the Clark, W.H., Jr.: A classifiation of malignant melanoma in man correlated with
tendo Achilles. J Foot Surg 29: 533, 1990 histogenesis and biologic behavior. In Montagna W, Hu F (eds): Advances in
Peroneal Tendon Dislocation – Eckert and Davis Biology and Skin, Vol 8, The Pigmentary System, Pergamon Press, New York,
Eckert WR, Davis EA Jr: Acute rupture of the peroneal retinaculum. J Bone Joint 1966: 612-647
Surg Am 1976 Jul; 58(5): 670-2 Malignant Melanoma – Breslow
Shotgun Injury – Sherman and Parrish Breslow, A.: Thickness, cross-sectional areas and depth of invasion in the
Sherman RT, Parrish RA: Management of shotgun injuries: A review of 152 cases. prognosis of cutaneous melanoma. Ann Surg 1970;172:902-908
J Trauma 3:76-86, 1963 Nail Injuries – Rosenthal
Shotgun Injury – Ordog Rosenthal EA. Treatment of fingertip and nail bed injuries, Orthop Clin North Am
Ordog GJ, Wasserberger J, Balasubramaniam S. Shotgun wound ballistics. J 14:675-697, 1983
Trauma 1988;28:624-631
Puncture Wounds – Green & Burno
Green NE, Bruno J. Pseudomonas infection of the foot after puncture wounds.
South Med J 1980; 73( 146-49).
Osteomyelitis – Buckholz
Buckholz, JM 1987. The surgical management of osteomyelitis: with special
reference to a surgical classification. J. Foot Surg. 26:S17-S24
Osteomyelitis – Cierny Mader
Cierny G, Mader JT: Adult chronic osteomyelitis. Orthopaedics 1984; 7
Osteomyelitis – Waldvogel
Waldvogel FA et al: Osteomyelitis: a review of clinical features, therapeutic
considerations and unusual aspects. N Engl J Med 1970 Jan 22; 282(4): 198-206
Osteomyelitis – Patzakis
Patzakis PJ, Calhoun JH, Cierny G, Holtom P, Mader JT, Nelson CL Symposium:
Current Concepts in the Management of Osteomyelitis. Contemporary
Orthopaedics, 28(2): 157-185 passim, 1994
Tarsal Coalitions – Downey