Current classification of fractures. Rationale and utility.

Fracture classification systems are used on a daily basis in any busy orthopedic clinic. They are an essential means by which physicians communicate, make treatment decisions, estimate prognosis, and report and compare results. Until recently, these classifications have been designed, accepted, and utilized without formal critique. By studying and understanding the shortcomings of previous systems, we can use this knowledge to construct better ones. Ideally, a fracture classification, like any classification, should be reliable, reproducible, all inclusive, mutually exclusive, logical, and clinically useful. The AO/ASIF classification of long bone fractures provides a unified scheme of classification for fractures of the entire skeleton. Despite addressing many of the faults of previous classifications, the observer agreement for this system drops to unacceptable levels at the group and subgroup levels. Further study is warranted to determine how this agreement can be improved.