Classifications

Diabetic Foot Ulcers

SINBAD Classification

  • Introduced in 2008 following a multicentric study, this classification evaluates diabetic foot ulcers based on six categories.
Category Definition Score
Site Forefoot 0
Hindfoot and midfoot 1
Ischemia Pedal blood flow intact (at least one pulse palpable) 0
Clinical evidence of reduced pedal blood flow 1
Neuropathy Protective sensation intact 0
Protective sensation absent 1
Bacterial Infection None 0
Present 1
Area Ulcer <1cm² 0
Ulcer ≥1cm² 1
Depth Ulcer confined to skin and subcutaneous tissue 0
Ulcer reaching muscle, tendon, or deeper 1

Meggitt-Wagner Classification

  • Most commonly used classification for diabetic foot ulcers.
Grade Description
0 No ulcer but foot deformity at risk of ulceration
1 Superficial ulcer
2 Deep ulcer with visible bone or tendon
3 Deep ulcer with abscess or osteomyelitis
4 Ulcer with gangrene limited to forefoot
5 Ulcer with gangrene of the whole foot

University of Texas Staging System

  • Second most commonly used classification, incorporating infection and ischemia.
Stage Grade 0 Grade 1 Grade 2 Grade 3
A Pre-/post-ulcerative lesion, epithelialized Superficial ulcer, not involving tendon Ulcer penetrating to tendon Ulcer penetrating to bone/joint
B Infection Infection Infection Infection
C Ischemia Ischemia Ischemia Ischemia
D Infection & ischemia Infection & ischemia Infection & ischemia Infection & ischemia

S(AD)SAD Classification

  • Assesses diabetic foot based on area, depth, sepsis, arteriopathy, and denervation.
Grade Area Depth Sepsis Arteriopathy Denervation
0 Skin intact Skin intact No infection Pedal pulses present Intact
1 Lesion <1cm² Superficial (skin and subcutaneous tissue) No infected lesions Pedal pulses reduced/one missing Reduced
2 Lesion 1–3cm² Penetrating to tendon, periosteum, joint Cellulitis-associated lesions Absence of both pedal pulses Absent
3 Lesion >3cm² Involving bones or joint space Lesions with osteomyelitis Gangrene Charcot joint

Charcot Foot: Eichenholz Classification

The Eichenholz Classification is used to stage Charcot neuroarthropathy, describing the progression of the condition through distinct radiological and clinical features.

Stage Name Features
0 Pre-Fragmentation Acutely painful, regional demineralization of bone visible on imaging.
1 Fragmentation Painful stage with peri-articular fragmentation, visible bone demineralization, and joint dislocations.
2 Coalescence Less pain, sclerosis (bone hardening), and bone resorption as fragments coalesce.
3 Remodelling Pain-free stage with malunited and/or ankylosed (stiffened) joints.

Osteochondral Defects of Talus: Berndt & Hardy Classification

Stage Features
1 Subchondral fracture
2 Partially detached fragment
3 Detached but stable fragment
4 Detached and unstable fragment – free-floating

MRI Classification by Bristol Group

Stage Definition
1 Articular cartilage injury
2a Articular cartilage injury with underlying fracture and surrounding edema
2b Articular cartilage injury with underlying fracture but no bony edema
3 Detached, undisplaced fragment
4 Detached, displaced fragment
5 Subchondral cyst

Occipital Condyle Fractures: Tuli Classification

Type Features
1 Stable, undisplaced fracture
2A Stable, displaced fracture with no ligamentous instability
2B Unstable, displaced fracture with ligamentous instability

Atlas (C1) Fractures: Jefferson Classification

Type Features
1 Posterior arch fracture
2 Anterior arch fracture
3 Fractures of both anterior and posterior arches
4 Lateral mass fracture

Hangman’s Fracture (Traumatic C2 Spondylolisthesis): Levine & Edwards Classification

Type Features
1 <3mm displacement, intact disc
2 >3mm displacement, disc usually intact (most common)
2a Angulation rather than displacement, disc likely extruded
3 Concurrent facet dislocation, extruded disc, high neurologic injury

PEG Fractures: Anderson Classification

Type Features
1 Avulsion from tip (apical or alar ligaments)
2 Waist, non-comminuted (most common)
2a Waist, comminuted (most unstable)
3 Into cancellous bone of C2 body with/without facets involvement

Eysel Classification for Type 2 PEG Fracture

Type Definition
A Horizontal
B Anteroposterior (anterosuperior to posteroinferior)
C Reverse

Spinal Muscular Atrophy (Chromosome 5): MDA Classification

Type Features Name
SMA1 Onset <6 months, death <2 years Werdnig-Hoffmann disease
SMA2 Onset by 2 years, death by 20 years Dubowitz disease
SMA3/4 Onset after 2 years, normal lifespan Kugelberg-Welander disease

Hereditary Sensory and Motor Neuropathy (HSMN): Charcot-Marie-Tooth Types

Type Features Genetic Inheritance
HSMN1/CMT1 Onset in teens, demyelination of nerves, absent reflexes, abnormal NCS Autosomal dominant
HSMN2/CMT2 Onset >20 years, milder, no demyelination but Wallerian degeneration Autosomal dominant
CMTX Intermediate severity X-linked
CMT4 Onset in infancy, severe Autosomal recessive

Dejerine-Sottas Disease

  • Defined clinically with onset by 2 years of age, delayed motor milestones, and severe motor/sensory and skeletal deficits.

  •  DSD is caused by autosomal dominant mutations in PMP22, MPZ, and EGR2

  • Due to its unique phenotypic features, classified as a separate group with hereditary neuropathy with liability to pressure palsies (HNPP)

Spina Bifida Types

Type Features
Occulta Defect in posterior elements but no extrusion
Meningocele Extrusion of dura only
Myelomeningocele Extrusion of neural elements contained by dura
Classic spina bifida Neural elements extruded and fully exposed
Rachischis Neural elements extruded and fully exposed; very severe

Capitellar Fractures: Bryan & Morrey Classification

Type Features
1 Complete, minimal extension into trochlea (Hans Steinhal)
2 Osteochondral defect (Kocher Lorenz)
3 Comminuted compressed fracture
4 Complete with significant extension into trochlea (“double bubble”)

Radial Head Fractures: Mason Classification

Type Features
1 Undisplaced
2 Marginal fracture displaced
3 Comminuted displaced fracture
4 Fracture with elbow dislocation

Radial Neck Fractures: Mason Classification

Type Features
1 Undisplaced
2 Displaced fracture
3 Displaced and comminuted fracture
4 Fracture with elbow dislocation

Coronoid Process: Morrey Classification

Type Features
1 Tip
2 <50% of the coronoid
3 >50% of the coronoid

Coronoid: O’Driscoll Classification

Type Subtype Description
Tip 1 <2mm coronoid height
2 >2mm coronoid height
Anteromedial 1 Rim
2 Rim and Tip
3 Involving sublime tubercle
Basal 1 Coronoid body and base
2 Transolecranon basal coronoid fracture

Tibialis Posterior Insufficiency (Johnson–Myerson Grade 4)

Grade Features
0 Asymptomatic with MRI changes
1 Tibialis posterior (TP) painful but competent
2 Incompetent TP with flexible planovalgus
3 Incompetent TP with fixed planovalgus
4 Fixed planovalgus with talar tilt

Hallux Valgus Severity

Severity HVA IMA
Normal <15° <8°
Mild 15–19° 8–13°
Moderate 20–40° 13–20°
Severe >40° >20°

Avascular Necrosis of the Hip (Ficat Classification)

Stage Features
1 XR normal – MRI or Bone scan positive
2 Sclerosis and cyst formation
3 Subchondral collapse – crescent sign
4 Significant collapse and arthrosis

Avascular Necrosis of the Hip (Steinberg Classification)

Stage Features
0 All imaging normal
1 XR normal, MRI or Bone scan positive
2 Sclerosis and cyst formation
3 Subchondral collapse – crescent sign
4 Head collapse, deformation, and flattening
5 Joint space narrowing
6 Severe arthrosis

Femoral Head Fracture Dislocations (Pipkin Classification)

Type Features AVN Rate
1 Dislocation with fracture inferior to fovea (non-weight-bearing zone) <5%
2 Dislocation with fracture superior to fovea (weight-bearing zone) <5%
3 Type 1 or 2 with associated neck fracture (worst prognosis) 50%
4 Type 1 or 2 with associated acetabular fracture 10%

Tibial Plateau (Schatzker)

Type Features Notes
1 Split Young
2 Split Depression Middle aged
3 Depression Elderly
4 Medial plateau only Likely knee dislocation
5 Both plateaus with metaphyseal continuity Axial compression
6 Both plateaus with metaphyseal discontinuity Axial compression

Stages of Elbow Instability

Stage Features
Stage 1

Only Ulna lateral collateral ligament disrupted

Posterolateral subluxation
Stage 2

All lateral collateral ligaments disrupted

Posterolateral dislocation – often perched

Stable on reduction
Stage 3A Lateral and medial (xpt anterior band) collateral ligaments disrupted Stable when reduced to valgus
Stage 3B

Complete disruption of MCL including anterior band

Unstable to valgus but stable in plaster at 90 degrees
Stage 3C

Avulsion of all soft tissue from distal humerus

Unstable in plaster without flexion >90 degrees

ASIA Scale of SCI

Injury Features
A Complete: No sensory or motor function below level
B Incomplete: Sensory function but no motor function below level
C Incomplete: Motor and sensory function below level. At least 50% muscles below level have grade 2 or less power
D Incomplete: At least 50% muscles below level have grade 3 or more power
E Normal motor and sensory function

Glenoid Fractures

Type Description
1A Anterior rim
1B Posterior rim
2 Transverse fracture exiting inferiorly
3 Transverse fracture exiting medial to coracoid
4 Transverse exiting at medial border scapula
5 Combination of 2 and 4
6 Comminuted glenoid

Calcaneal Fractures – Sanders

Grade Features
1 Undisplaced no matter how many fracture lines
2 (A, B, C) 1 fracture line causing 2 displaced fragments
3 (A, B, C) 2 fracture lines causing 3 displaced fragments
4 3 or more fracture lines with multiple fragments

Soft Tissue Injuries – Tscherne

Grade Features
0 Indirect force. Negligible soft tissue damage. No skeletal injury.
1 Low energy fracture. Superficial contusion/abrasion.
2 High energy skeletal injury. Degloving or avulsion of soft tissues. High risk of compartment syndrome.
3 Extensive crushing mechanism injury. Partial or complete amputation. Impending or established compartment syndrome.

Open Fractures – Gustillo Anderson

Grade Features
1 Puncture <1cm. Simple low energy fracture.
2 Laceration >1cm. Simple low energy fracture.
3a Large or contaminated soft tissue injury. High energy fracture pattern/mechanism. Primary soft tissue coverage possible.
3b As 3a but requires plastics for soft tissue coverage.
3c Vascular injury.

Acetabular Fractures – Letournel

Type Description
Elemental Posterior Wall
Posterior Column
Anterior Wall
Anterior Column
Transverse
Associated Posterior Wall & Posterior Column
Transverse and Posterior Wall
Anterior Column and Posterior Hemitransverse
T Type
Both Column

Pelvic Fractures – Tile

Grade Features
A Stable in all planes
B Rotationally unstable
C Rotationally & vertically unstable (posterior SI ligaments gone)

Pelvic Fractures – Young & Burgess

Grade Features
APC Symphysis diastasis +/- SI joint widening. A&P SIJ ligaments intact.
Ant SIJ ligament torn. Post SIJ ligament intact.
A&P SIJ ligaments torn. Vertical displacement.
LC Horizontal pubic ramus Fx. Sacral compression Fx. Crescent fracture.
VS Vertically displaced hemipelvis. Symphysis and SIJ vertical displacement or vertical ramus and sacral fracture.
Combined VS + LC, APC + VS, APC + LC

Periprosthetic Hip – Vancouver

Type Features
AG Greater trochanter
AL Lesser trochanter
B1 At level of stem or just distal to tip. Well-fixed. Good bone stock.
B2 At level of stem or just distal to tip. Loose. Good bone stock.
B3 At level of stem or just distal to tip. Loose. Loss of bone stock.
C Distal to Stem. Stem unaffected.

Impending Pathologic Fracture – Mirel’s

Score 1 2 3
Location Upper Limb Lower Limb Proximal Femur
Appearance Sclerotic Mixed Lytic
Size <1/3 <2/3 >2/3
Pain No Pain Moderate Pain Unable to WB
Note 8 or more suggests impending fracture

Monteggia Fracture – Bado

Type Features Notes
1 Anterior dislocation of radial head 70%
2 Posterior dislocation of radial head 5%
3 Lateral dislocation of radial head 25%
4 Associated radial shaft fracture <5%

MESS Score

Score 0 1 2 3 4
Age <30 30-50 >50
Shock Systolic >90 Transient hypotension Persistent hypotension
Limb Ischemia Reduced Pulse. Perfused limb Pulseless. Parasthesia. Increased CR Insensate. Cold. Paralysed
Skeletal/Soft Tissue Injury Low Energy Moderate energy (open Fx) High Energy (RTA) Very High Energy (Crush, RTA, Contaminated)
Note Ischaemia score doubled if ischaemia time >6 hours. Total score of 8 or more suggests limb may not be viable.

Classification of Rheumatoid Thumb - Naelbuf

Type Deformity
Type 1 Boutonniere (MCPJ flexion) most common
Type 2 Boutonniere with CMCJ dislocation or arthritis (rare)
Type 3 Swan Neck (CMCJ adduction and flexion, MCPJ extension)
Type 4 Ulna collateral ligament laxity
Type 5 Swan Neck with no adduction of metacarpal (rare)
Type 6 Mutilating disease – gross joint destruction

TFCC Tears – Palmer Classification

Type 1 – Traumatic

Type Features
1A Central perforation (debride)
1B Ulna styloid avulsion
1C Distal avulsion (triquetrum)
1D Radial Avulsion

Type 2 – Degenerative

Type Features
2A Thinning of TFCC but no perforation
2B-E Progressive arthrosis affecting carpal joints and DRUJ

Scaphoid Fractures

Russe – Pattern

Pattern Description
Transverse
Horizontal Oblique
Vertical Oblique Most unstable

Stability – Herbert

Stability Features
Stable <1mm displacement
Unstable >1mm displacement or gap, >60 degrees scapholunate angle, >15 degrees Radio-lunate angle, Comminution, Proximal Pole, Vertical Oblique fracture pattern

Anatomic Location

Location
Proximal Pole
Waist
Distal Pole
Tuberosity

Keinbock’s Disease – Lichtman

Stage Features Management
1 XR Normal. MRI low signal Non-operative surveillance
2 Sclerotic Lunate. No collapse or fragmentation Joint Levelling, Core Decompression, Vascularised Grafting
3A Lunate collapse. No Instability. Scaphoid not rotated or fixed Joint Levelling, Core Decompression, Vascularised Grafting (less predictable than stage 2), Limited Fusion
3B Lunate Collapse. Reduced Carpal height. Instability – scaphoid in fixed rotation Limited Fusion, PRC
4 Pancarpal Arthrosis Wrist Fusion, PRC (not if capitate affected)

Classification of SLAP Tears – Schneider

Type Description Management
Type 1 Fraying of superior labrum, intact biceps anchor Debride
Type 2 Unstable Biceps Anchor Re-attach
Type 3 Bucket handle detachment of superior labrum from intact biceps anchor Debride
Type 4 Bucket handle detachment of whole biceps anchor with propagation into LHB tendon Re-attach +/- LHB tenotomy
Type 5 SLAP with Labral tear Reattach both
Type 6 Superior flap tear Debride
Type 7 SLAP with capsular tear Fix and reattach

Rheumatoid Arthritis Elbow – Larsen

Grade Features
1 Soft tissue inflammation & periarticular osteoporosis
2 Joint space narrowing
3 Significant joint space narrowing
4 Subchondral bony erosion and arthrosis
5 Severe arthritis with deformity

Thumb CMCJ Arthritis – Eaton

Stage Features
Stage 1 Joint space widened, <1/3 subluxation
Stage 2 Decreased joint space, Marginal Osteophytes <2mm, 1/3 joint subluxation
Stage 3 Significant arthrosis, Sclerosis and cysts, Osteophytes >2mm, >1/3 subluxation
Stage 4 STT arthritis

Hallux Rigidus – Coughlin

Grade X-Ray Pain MTPJ Motion
0 Normal None Minimal stiffness
1 Minimal narrowing Intermittent Mild restriction
2 Narrowing & Osteophytes Almost constant Moderate restriction
3 Severe arthrosis Constant None at mid range (<20 degrees)
4 Severe arthrosis Pain at mid range <20 degrees

AVN Humeral Head – Creuss

Stage Features
1 XR Normal, MRI abnormal
2 Sclerosis on XR
3 Subchondral Collapse (‘Crescent sign’)
4 Humeral head collapse, Glenoid normal
5 Humeral head and Glenoid Arthrosis & Erosion

Classification of Cerebral Palsy

Type

Type Features
Spastic UMN symptoms predominate
Athetoid Flaccidity – rare
Ataxic Cerebellar symptoms predominate

Geographic

Type Features
Quadriplegic Whole body involvement
Diplegic Lower limbs only
Hemiplegic Unilateral involvement – rare

Gross Motor Function Classification System (GMFCS)

Type Features
GMFCS 1 Able to walk independently
GMFCS 2 Occasional difficulty walking on slopes or in crowds
GMFCS 3 Requires a walking aid. Can self propel a wheelchair
GMFCS 4 Can transfer only. Supports own head in wheelchair
GMFCS 5 Wheelchair bound. Unable to support head

Perthes Disease – Herring Lateral Pillar Height

Stage Lateral Pillar Height
A Normal
B >50%
B/C 50% with narrowing of physis
C <50%

Cervical Spine Rheumatoid Arthritis Severity – Ranawat

Stage Features
1 No neurologic findings – pain only
2 Subjective neurology
3a Objective neurology & UMN signs – patient ambulatory
3b Objective neurology & UMN signs – patient not ambulatory

3b do poorly with surgery – identify and operate earlier.

Ferguson Mechanistic Classification of Sub-Axial Fractures

Type Examples Notes
Flexion Compression Flexion tear drop High rate neuro injury. Surgical management
Flexion Distraction Facet Dislocation High Rate neuro injury. Surgical management
Axial Burst Fracture Management depends on features of instability and neurology
Extension Compression Isolated posterior element fractures Low incidence neuro injury. Highly unstable though - surgery
Extension Lateral Compression Beware: associated plexus injury

Spondylolisthesis

Myerding – Degree Slip

Grade Features
Grade 1 0 -25%
Grade 2 25-50%
Grade 3 50-75%
Grade 4 75-100%
Grade 5 >100% (spondyloptosis)

Wiltse – Type

Type Features
1 (Dysplastic) L5/S1, Intact neural arch, max 30% slip, L5 inferior facet poorly formed, S1 superior facet absent, Trapezoidal L5. Girls & Eskimo’s
2 (Isthmic) Stress fracture pars, Elongated Pars, Acute Fracture Pars. Boys & Eskimo’s. Sagittally oriented facets – not dysplastic, <25% slip usually
3 (Degenerative) Women, Diabetic, Black, >40 years, L4/5
4 (Traumatic)
5 (Pathologic)
6 (Iatrogenic)

Nerve Injury – Seddon and Sunderland

Type Features Sunderland Grade Prognosis
Neuropraxia No Wallerian Degeneration, segmental demyelination, conduction block, epineurial damage Grade 1 Good
Axonotmesis Wallerian degeneration distal to injury, axonal damage, conduit for regeneration intact Grade 2-4 Okay
Neurotmesis Wallerian degeneration beyond injury, endoneurium violated, no conduit for regeneration Grade 5 Poor

Sacral Fractures – Denis

Type Features Notes
Zone 1 Lateral to foramina 50% of fractures; 5% neurologic injury
Zone 2 Through the foramina 30% of fractures; 30% neurologic injury
Zone 3 Medial to foramina 20% of fractures; 60% neurologic injury

Femoral Head Fracture Dislocation – Pipkin

Type Features AVN Rate
1 Dislocation with fracture inferior to fovea (NWB zone) <5%
2 Dislocation with fracture superior to fovea (WB zone) <5%
3 Type 1 or 2 with associated neck fracture (worst) 50%
4 Type 1 or 2 with associated acetabular fracture 10%

Bone Tumors – Enneking

Type Grade Intra/Extra Compartmental Metastases
1A Low Intra None
1B Low Extra None
2A High Intra None
2B High Extra None
3A Any Intra Mets
3B Any Extra Mets

SUFE Severity – Southwick Angle

Severity Features
Mild <30 degrees
Moderate 30-50 degrees
Severe >50 degrees

Talar Neck Fractures – Hawkins

Type Features AVN Non-Union STJ OA
1 Undisplaced 10% 2% 25%
2 Displaced with STJ subluxation 50% 8% 65%
3 Displaced with STJ & Ankle subluxation 90% 10% 70%
4 Displaced with STJ, TTJ & TNJ subluxation 100% 20% 90%

Discoid Meniscus

Type Features
Incomplete Partial coverage
Complete Full coverage
Wrisberg Variant Only attachment is meniscofemoral ligaments

Meniscal Tears – Tear Pattern

Pattern Subtypes Features
Vertical Longitudinal (Bucket Handle) Bucket handles propagate longitudinally
Horizontal Full or Partial Cleavage Flap tears most common
Complex Combinations of above patterns

Adult Hip Dysplasia – Crowe

Type Features
1 <50% migration
2 50-75% migration
3 75-100% migration
4 >100% migration

Classification of Tibial Bone Defects in TKR

Type Features Management
1 <1 cm focal defect, cortical rim intact Fill with cement
2 Contained defect, cortical rim intact Cancellous autograft and cement
3 Uncontained defect, no cortical rim intact Metallic augments, allograft, revision stems

Knee Dislocation - Schenk

Stage Features
KD1 ACL or PCL (very rare)
KD2 ACL & PCL only
KD3M ACL, PCL & MCL
KD3L ACL, PCL & LCL
KD4 ACL, PCL, MCL, LCL
KD5 Fracture Dislocation

Clavicle Fractures – Neer

Type Features
Type 1 Middle 1/3
Type 2 Distal 1/3
Type 3 Proximal 1/3
2a Minimally displaced
2b Displaced – fracture medial to CC ligaments
2c Intra-articular – both CC ligaments tend to be torn
2d Paediatric periosteal sleeve avulsion
2e Comminuted
3a-e Same system as for type 2 fractures

Graf Classification of DDH

Type Alpha angle Features
1 >60 degrees Normal enlocated hip
2 43-60 degrees Borderline group, may or may not be abnormal
3 <43 degrees & labrum everted Hip subluxated
4 <43 degrees & labrum interposed Hip dislocated

Denis – 3 Column Theory of Spinal Stability

Fracture Type Columns Affected
Compression Anterior column only
Flexion Distraction Middle and Posterior tension failure, Anterior column intact as a hinge
Burst Anterior & Middle column co mpression failure
Fracture Dislocation All three columns disrupted
Anterior Column ALL, Anterior 2/3 vertebral body and disc
Middle Column Posterior 1/3 vertebral body and disc, PLL
Posterior Column Neural arches

Swanson’s Classification of Congenital Anomalies

Type Examples
Failure of Formation Transverse or longitudinal arrest, Pre or post axial, Amelia, Radial or Ulna club Hand
Failure of Differentiation Bony or Soft tissue, Syndactyly, Camptodactyly, Clinodactyly, Duplication, Pre or post axial, Polydactyly, Thumb duplication
Overgrowth Hyperplasia
Undergrowth Hypoplasia
Constriction Bands Generalised syndromes, Madelung’s

Wassel’s Classification of Thumb Duplications

Type Features
1 Bifid P3
2 Duplicated P3
3 Bifid P2
4 Duplicated P2 (most common)
5 Bifid P1
6 Duplicated P1
7 Triphalangism

Classification of Articular Cartilage Degeneration (Jackson)

Grade Features
1 Softening
2 Fibrillation and fissuring
3 Partial thickness defects with flaps and clefts
4 Full Thickness defects with exposed subchodral bone

Lauge Hansen Classification of Ankle Fractures

Mechanism Features
Supination External Rotation AITFL or Chaput fragment, Oblique Weber B Fibula Fracture in a posterior superior to anterior inferior direction, PITFL or Posterior Malleolus Fracture, Medial Malleolar T ransverse Fracture
Supination Adduction T ransverse Weber A fibula fracture, Vertical Medial Malleolar Fracture
Pronation External Rotation Medial Malleolus Fracture, AITFL or Chaput, Oblique/spiral Weber C fracture in anterior superior to posterior inferior direction, PITFL or Posterior Malleolus Fracture
Pronation Abduction T ransverse Medial Malleolar Fracture, AITFL, PITFL or Chaput, Simple or Butterfly Weber C (bending injury)

Paprosky Classification of Femoral Defects

Type Features
1 Minimal Metaphyseal bone loss, Normal Diaphyseal bone stock
2 Moderate Metaphyseal bone loss, Normal Diaphyseal bone stock
3a Significant metaphyseal bone loss, Diaphyseal bone loss with >4cm isthmus for fixation
3b Significant metaphyseal bone loss, Diaphyseal bone loss with <4cm isthmus for fixation
4 Inadequate diaphyseal bone for long stem fixation

Paprosky Classification of Acetabular Defects

Type Features
1 Minimal Bone loss; Minimal migration; Fully stable cup
2a Superior migration, Superior Bone loss, Stable cup, Rest of Acetabulum ok
2b Superior migration, Uncontained superior bone defect, >50% bone contact, Stable cup
2c Medial migration past kohler’s line, Uncontained medial defect, Stable cup, >50% contact
3a Superior migration, Moderate ischial, teardrop lysis, No significant medial migration, Partial stability of cup, 40% contact
3b Large uncontained defects, Significantly migrated cup – superior or medial to kohler’s line, Bone contact <40%, Risk of pelvic discontinuity, Unstable cup

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