Injury (1993)24, (S), 309-312 zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA Printed in Great Britain 309 The A0 classification of long bone fractures: an early study of its use in clinical practice zyxwvutsrqponmlkjihgfedcba M. L. Neweyl, D. Ricketts’ and L. Roberts1 ‘The Princess Royal Hospital,HaywardsHeath,West Sussexand ‘St Mary’s Hospital, London, UK Over a period of 6 monfhs, 543 long bone fracfures were classified using the A0 classification system. Factors important zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA in determining the manage- ment of fractures occurring in three regions; hip, forearm and tibia, were identified. In hip fractures, we found that the anatomical configuration of fhe fracture, and therefore its classificafion, generally determined management. However, there were other factors thaf influenced the more specific form of surgical treatment used. In forearm zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA fractures, the age of the patient was fhe most important factor determining treatment,while many factors, including consultanf preference, determined the treatrnenf of fibialfrachtres. While we found fhe system useful for audit purposes, we also found that if was unnecessarily complicated ana’ offen fell short of playing a useful role in the planning of management. Introduction Several systemsare currently in use for classifying fractures. In general, theiraims are to indicate the nature of the injury and provide a rationale for treatment. We have usedthe A0 system to classify long bone fractures occurring in patients admitted to our units. This paper examines our early experience of its use. Patients and methods Over a 6-month period, 676 patients were admittedto our units with fractures. Of these, 161 (23.8 per cent) had fractures of bones other than long bones. There were 515 patients with a total of 558 fractures involving long bones. Of these fractures, 15 (2.7 per cent) could not be classified with the A0 system. The classification of the remaining 543 fractures is given in Figure I. In order to evaluateour use of thesystem, we studied three regions;radius/ulnashaft,proximal femur and tibia/ fibulashaft. The distribution of fractures within each region was identified and factors affecting management deter- mined. Results The classification of fractures and eventual management are sho wn (Table I). The principal factors determining treatment for each region were identified as follows. 0 1993 Buttenvorth-Heinemann Ltd 0020-1383/93/050309-04 zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA Patients with hip fractures There were 191 patients admitted with hip fractures. Of these,82 patients (average age 81.1 years) were treated by hemiarthroplasty, 78 patients (average age 83.1 years) with dynamic hip screw fixation and 23 patients (averageage 68.1 years) by A0 cannulated screws.Of the remainder, two patientswith osteoarthritis of the injured hip under- went total hip replacement, two patientswere treatedby gamma nails and one by a Reconnail. There were three patients treated non-operatively. The most important factor determining management was the anatomical configuration of the fracture, beingeither extracapsular or intracapsular. In the A0 classification this broadly corresponds to the groups 3 l.A and 3 l.B, respectively. However,theirfurther division into subgroups was not helpful. We found thatotherfactors determined whether,for instance, a patient with an intra- capsular fracture was treated with a hemiarthroplasty or by internal fixation (Figure 2). Patients with forearm fractures There were 32 patients with forearm fractures. Of these, 18 patients (average age 13.1 years) were treated by closed 39 1 l-l 11 12 13 21 22 23 31 32 33 41 42 43 44 191 71 A0 classification of fractures Figure 1. Distribution of patients betweenregionsaccording to the A0 classification.