AO classification
AO classification

The Müller AO Classification of fractures is a system for classifying bone fractures initially published in 1987 by the AO Foundation as a method of categorizing injuries according to therognosis of the patient's anatomical and functional outcome. "AO" is an initialism for the German "Arbeitsgemeinschaft für Osteosynthesefragen", the predecessor of the AO Foundation.

It is one of the few complete fracture classification systems to remain in use today after validation.

Comprehensive classification of the long bones

The English language version of the system allows consistent in detail description of a fracture in defined terminology by creating a 5-element alphanumeric code:

LocalisationMorphology
BoneSegmentTypeGroupSubgroup
1/2/3/41/2/3/(4)A/B/C1/2/3.1/.2/.3

Localisation

First, each fracture is given 2 numbers to describe which bone it affects, and where in the bone:

1234
BoneHumerusRadius and UlnaFemurTibia and fibula
SegmentProximal segmentDiaphyseal segmentDistal segmentMalleolar segment (only used with tibia and fibula

Type

Each fracture is next given a letter (A, B or C) to describe the joint involvement of the fracture:

SegmentABC
1Extra-articularPartial articularComplete articular
2SimpleWedgeComplex
3Extra-articularPartial articularComplete articular

The exceptions to this step include:

LocalisationABC
11 - Proximal humerusExtra-articular, unifocalExtra-articular, bifocalArticular
31 - Proximal femurExtra-articular, trochantericExtra-articular, neckArticular, head
44 - MalleoliInfrasydesmoticTransyndesmoticSuprasyndesmotic

Groups & Subgroups

Finally, the fracture is given 2 further numbers to denote the fracture pattern and geometry.

For segment 2 (diaphyseal) fractures:

TypeGroup
123
A - simpleSpiralObliqueTransverse
B - wedgeSpiralBendingMultifragmentory
C - complexSpiralSegmentalIrregular

For segment 1 and 3 (epiphyseal and metaphyseal) fractures:

TypeGroup
123
A - extra-articularSimpleWedgeComplex
B - partial articularSplitDepressionSplit-depression
C - articularSimple articular, simple metaphysealSimple articular, complex metaphysealComplex articular, complex metaphyseal

Subgroups are then used to describe the fractures in terms of displacement (versus apposition, which is the degree to which the parts are in contact with each other), rotation, angulation and shortening.

AO pediatric comprehensive classification of long bone fractures

A pediatric version of the long-bone classification was published in 2006 to further classify fractures of immature bone and so the effects on future growth:

LocalisationMorphology
BoneSegmentTypeChildSeverityExceptions
1/2/3/41/2/3E/M/D1-9.1/.2I-IV

OTA/AO Classification unifying extension

The Orthopaedic Trauma Association Committee for Coding and Classification initially published their classification system covering the whole skeleton in 1996. In 2006 they published a revision, unifying the Muller/AO and OTA systems into a single alphanumeric classification, which has been further updated in 2018:

LocalisationRegion/Bone
BoneSegment
14Scapula
5Clavicle
34Patella
51Cervical spine
2Thoracic spine
3Lumbar spine
61Pelvic ring
2Acetabulum
71Lunate
2Scaphoid
3Capitate
4Hamate
5Triquetrum and Pisiform
6Trapezium and Trapezoid
7Metacarpus
8Phalanges
9Multiple fractures
81Talus
2Calcaneus
3Navicular
4Cuboid
5Cuneiforms
7Metatarsus
8Phalanges
9Multiple fractures
91Craniomidface
2Mandible

External links