scholarly journals The First AO Classification System for Fractures of the Craniomaxillofacial Skeleton: Rationale, Methodological Background, Developmental Process, and Objectives

2014 ◽  
Vol 7 (1_suppl) ◽  
pp. 6-14 ◽  
Author(s):  
◽  
Laurent Audigé ◽  
Carl-Peter Cornelius ◽  
Antonio Di Ieva ◽  
Joachim Prein
Keyword(s):  
Classification System ◽  
Developmental Process ◽  
Evaluation Process ◽  
Fracture Morphology ◽  
Fracture Pattern ◽  
Classification Systems ◽  
Case Examples ◽  
Introductory Article ◽  
Comprehensive Classification ◽  
Multispecialty Group

Validated trauma classification systems are the sole means to provide the basis for reliable documentation and evaluation of patient care, which will open the gateway to evidence-based procedures and healthcare in the coming years. With the support of AO Investigation and Documentation, a classification group was established to develop and evaluate a comprehensive classification system for craniomaxillofacial (CMF) fractures. Blueprints for fracture classification in the major constituents of the human skull were drafted and then evaluated by a multispecialty group of experienced CMF surgeons and a radiologist in a structured process during iterative agreement sessions. At each session, surgeons independently classified the radiological imaging of up to 150 consecutive cases with CMF fractures. During subsequent review meetings, all discrepancies in the classification outcome were critically appraised for clarification and improvement until consensus was reached. The resulting CMF classification system is structured in a hierarchical fashion with three levels of increasing complexity. The most elementary level 1 simply distinguishes four fracture locations within the skull: mandible (code 91), midface (code 92), skull base (code 93), and cranial vault (code 94). Levels 2 and 3 focus on further defining the fracture locations and for fracture morphology, achieving an almost individual mapping of the fracture pattern. This introductory article describes the rationale for the comprehensive AO CMF classification system, discusses the methodological framework, and provides insight into the experiences and interactions during the evaluation process within the core groups. The details of this system in terms of anatomy and levels are presented in a series of focused tutorials illustrated with case examples in this special issue of the Journal.

scholarly journals The Comprehensive AO CMF Classification System for Mandibular Fractures: A Multicenter Validation Study

2019 ◽  
Vol 12 (4) ◽  
pp. 254-265 ◽  
Author(s):  
Paul A. Mittermiller ◽  
Serena S. Bidwell ◽  
Florian M. Thieringer ◽  
Carl-Peter Cornelius ◽  
Amber W. Trickey ◽  
...  
Keyword(s):  
Classification System ◽  
Interobserver Reliability ◽  
Fracture Morphology ◽  
Mandibular Fractures ◽  
Condylar Process ◽  
Accuracy Study ◽  
Level 3 ◽  
Comprehensive Classification ◽  
Level 2 ◽  
Condylar Neck

The AO CMF has recently launched the first comprehensive classification system for craniomaxillofacial (CMF) fractures. The AO CMF classification system uses a hierarchical framework with three levels of growing complexity (levels 1, 2, and 3). Level 1 of the system identifies the presence of fractures in four anatomic areas (mandible, midface, skull base, and cranial vault). Level 2 variables describe the location of the fractures within those defined areas. Level 3 variables describe details of fracture morphology such as fragmentation, displacement, and dislocation. This multiplanar radiographic image-based AO CMF trauma classification system is constantly evolving and beginning to enter worldwide application. A validation of the system is mandatory prior to a reliable communication and data processing in clinical and research environments. This interobserver reliability and accuracy study is aiming to validate the three current modules of the AO CMF classification system for mandible trauma in adults. To assess the performance of the system at the different precision levels, it focuses on the fracture location within the mandibular regions and condylar process subregions as core components giving only secondary attention to morphologic variables. A total of 15 subjects individually assigned the location and features of mandibular fractures in 200 CT scans using the AO CMF classification system. The results of these ratings were then statistically evaluated for interobserver reliability by Fleiss’ kappa and accuracy by percentage agreement with an experienced reference assessor. The scores were used to determine if the variables of levels 2 and 3 were appropriate tools for valid classification. Interobserver reliability and accuracy were compared by hierarchy of variables (level 2 vs. level 3), by anatomical region and subregion, and by assessor experience level using Kruskal-Wallis and Wilcoxon's rank-sum tests. The AO CMF classification system was determined to be reliable and accurate for classifying mandibular fractures for most levels 2 and 3 variables. Level 2 variables had significantly higher interobserver reliability than level 3 variables (median kappa: 0.69 vs. 0.59, p < 0.001) as well as higher accuracy (median agreement: 94 vs. 91%, p < 0.001). Accuracy was adequate for most variables, but lower reliability was observed for condylar head fractures, fragmentation of condylar neck fractures, displacement types and direction of the condylar process overall, as well as the condylar neck and base fractures. Assessors with more clinical experience demonstrated higher reliability (median kappa high experience 0.66 vs. medium 0.59 vs. low 0.48, p < 0.001). Assessors with experience using the classification software also had higher reliability than their less experienced counterparts (median kappa: 0.76 vs. 0.57, p < 0.001). At present, the AO CMF classification system for mandibular fractures is suited for both clinical and research settings for level 2 variables. Accuracy and reliability decrease for level 3 variables specifically concerning fractures and displacement of condylar process fractures. This will require further investigation into why these fractures were characterized unreliably, which would guide modifications of the system and future instructions for its usage.

scholarly journals The Comprehensive AOCMF Classification: Skull Base and Cranial Vault Fractures — Level 2 and 3 Tutorial

2014 ◽  
Vol 7 (1_suppl) ◽  
pp. 103-113 ◽  
Author(s):  
Antonio Di Ieva ◽  
Laurent Audigé ◽  
Robert M. Kellman ◽  
Kevin A. Shumrick ◽  
Helmut Ringl ◽  
...  
Keyword(s):  
Skull Base ◽  
Classification System ◽  
Fracture Morphology ◽  
Cranial Vault ◽  
Diagnostic Features ◽  
Base Surface ◽  
Case Examples ◽  
Fracture Location ◽  
Level 3 ◽  
Level 2

The AOCMF Classification Group developed a hierarchical three-level craniomaxillofacial classification system with increasing level of complexity and details. The highest level 1 system distinguish four major anatomical units, including the mandible (code 91), midface (code 92), skull base (code 93), and cranial vault (code 94). This tutorial presents the level 2 and more detailed level 3 systems for the skull base and cranial vault units. The level 2 system describes fracture location outlining the topographic boundaries of the anatomic regions, considering in particular the endocranial and exocranial skull base surfaces. The endocranial skull base is divided into nine regions; a central skull base adjoining a left and right side are divided into the anterior, middle, and posterior skull base. The exocranial skull base surface and cranial vault are divided in regions defined by the names of the bones involved: frontal, parietal, temporal, sphenoid, and occipital bones. The level 3 system allows assessing fracture morphology described by the presence of fracture fragmentation, displacement, and bone loss. A documentation of associated intracranial diagnostic features is proposed. This tutorial is organized in a sequence of sections dealing with the description of the classification system with illustrations of the topographical skull base and cranial vault regions along with rules for fracture location and coding, a series of case examples with clinical imaging and a general discussion on the design of this classification.

scholarly journals The Comprehensive AOCMF Classification System: Classification and Documentation within AOCOIAC Software

2014 ◽  
Vol 7 (1_suppl) ◽  
pp. 114-122 ◽  
Author(s):  
Laurent Audigé ◽  
Carl-Peter Cornelius ◽  
Christoph Kunz ◽  
Carlos H. Buitrago-Téllez ◽  
Joachim Prein
Keyword(s):  
Classification System ◽  
Fracture Morphology ◽  
Illustrative Case ◽  
Clinical Documentation ◽  
Fracture Classification ◽  
Anatomical Structures ◽  
Case Examples ◽  
Level 3 ◽  
Level 1 ◽  
Level 2

The AOCMF Classification Group developed a hierarchical three-level craniomaxillofacial (CMF) fracture classification system. The fundamental level 1 distinguishes four major anatomical units including the mandible (code 91), midface (code 92), skull base (code 93) and cranial vault (code 94); level 2 relates to the location of the fractures within defined topographical regions within each units; level 3 relates to fracture morphology in these regions regarding fragmentation, displacement, and bone defects, as well as the involvement of specific anatomical structures. The resulting CMF classification system has been implemented into AO comprehensive injury automatic classifier (AOCOIAC) software allowing for fracture classification as well as clinical documentation of individual cases including a selected sample of diagnostic images. This tutorial highlights the main features of the software. In addition, a series of illustrative case examples is made available electronically for viewing and editing.

scholarly journals The Comprehensive AOCMF Classification System: Condylar Process Fractures - Level 3 Tutorial

2014 ◽  
Vol 7 (1_suppl) ◽  
pp. 44-58 ◽  
Author(s):  
Andreas Neff ◽  
Carl-Peter Cornelius ◽  
Michael Rasse ◽  
DanielDalla Torre ◽  
Laurent Audigé
Keyword(s):  
Classification System ◽  
Fracture Pattern ◽  
Fracture Site ◽  
Classification Systems ◽  
Head Region ◽  
Condylar Process ◽  
Level 3 ◽  
Condylar Head ◽  
Ramus Height ◽  
Condylar Neck

This tutorial outlines the detailed system for fractures of the condylar process at the precision level 3 and is organized in a sequence of sections dealing with the description of the classification system within topographical subdivisions along with rules for fracture coding and a series of case examples with clinical imaging. Basically, the condylar process comprises three fracture levels and is subdivided into the head region, the condylar neck, and the condylar base. Fractures of the condylar head show typical fracture lines either within the lateral pole zone, which may lead to loss of vertical height, or medially to the pole zone, with the latter ones usually not compromising the vertical condyle to fossa relation. In condylar head fractures, the morphology is further described by the presence of minor or major fragmentation, the vertical apposition of fragments at the plane of the head fracture, the displacement of the condylar head with regard to the fossa including a potential distortion of the condylar head congruency resulting in dystopic condyle to fossa relations and the presence or absence of a loss of vertical ramus height. A specific vertical fracture pattern extending from the head to the neck or base subregion is considered. Fractures of the condylar neck and base can be differentiated according to a newly introduced one-third to two-thirds rule with regard to the proportion of the fracture line above and below the level of the sigmoid notch, which is presented in the classification article, and are basically subdivided according to the presence or absence of displacement or dislocation. In both condylar neck and base fractures, the classification is again based on the above mentioned parameters such as fragmentation, displacement of the condylar head with regard to the fossa, including dystopic condyle to fossa relations and loss of vertical ramus height, that is, according to the measurement of the condylar process. In addition, the classification assesses a sideward displacement including the respective displacement sector at the neck or base fracture site as well as the angulation of the superior main fragment and also considers a potential displacement of the caudal fragment with regard to the fossa, which may occur in fractures affecting additional fracture locations in the mandible. The design of this classification is discussed along with a review of existing classification systems. The condylar process for fracture location was defined according to the level 2 system presented in a previous tutorial in this special issue.

scholarly journals Toward the Development of a Comprehensive Clinically Oriented Patient Profile: A Systematic Review of the Purpose, Characteristic, and Methodological Quality of Classification Systems of Adult Spinal Deformity

Neurosurgery ◽  
2021 ◽  
Author(s):  
Kenny Yat Hong Kwan ◽  
J Naresh-Babu ◽  
Wilco Jacobs ◽  
Marinus de Kleuver ◽  
David W Polly ◽  
...  
Keyword(s):  
Systematic Review ◽  
Decision Making ◽  
Classification System ◽  
Methodological Quality ◽  
Literature Search ◽  
Adult Spinal Deformity ◽  
Classification Systems ◽  
Systematic Literature Search ◽  
Patient Profile

Abstract BACKGROUND Existing adult spinal deformity (ASD) classification systems are based on radiological parameters but management of ASD patients requires a holistic approach. A comprehensive clinically oriented patient profile and classification of ASD that can guide decision-making and correlate with patient outcomes is lacking. OBJECTIVE To perform a systematic review to determine the purpose, characteristic, and methodological quality of classification systems currently used in ASD. METHODS A systematic literature search was conducted in MEDLINE, EMBASE, CINAHL, and Web of Science for literature published between January 2000 and October 2018. From the included studies, list of classification systems, their methodological measurement properties, and correlation with treatment outcomes were analyzed. RESULTS Out of 4470 screened references, 163 were included, and 54 different classification systems for ASD were identified. The most commonly used was the Scoliosis Research Society-Schwab classification system. A total of 35 classifications were based on radiological parameters, and no correlation was found between any classification system levels with patient-related outcomes. Limited evidence of limited quality was available on methodological quality of the classification systems. For studies that reported the data, intraobserver and interobserver reliability were good (kappa = 0.8). CONCLUSION This systematic literature search revealed that current classification systems in clinical use neither include a comprehensive set of dimensions relevant to decision-making nor did they correlate with outcomes. A classification system comprising a core set of patient-related, radiological, and etiological characteristics relevant to the management of ASD is needed.

scholarly journals UV Spectral Classification of B Stars

1985 ◽  
Vol 111 ◽  
pp. 411-413
Author(s):  
Janet Rountree ◽  
George Sonneborn ◽  
Robert J. Panek
Keyword(s):  
Classification System ◽  
Classification Criteria ◽  
High Dispersion ◽  
Spectral Classification ◽  
Early Type ◽  
B Stars ◽  
Dimensional Classification ◽  
Early Type Stars ◽  
Comprehensive Classification

Previous studies of ultraviolet spectral classification have been insufficient to establish a comprehensive classification system for ultraviolet spectra of early-type stars because of inadequate spectral resolution. We have initiated a new study of ultraviolet spectral classification of B stars using high-dispersion IUE archival data. High-dispersion SWP spectra of MK standards and other B stars are retrieved from the IUE archives and numerically degraded to a uniform resolution of 0.25 or 0.50 Å. The spectra (in the form of plots or photowrites) are then visually examined with the aim of setting up a two-dimensional classification matrix. We follow the method used to create the MK classification system for visual spectra. The purpose of this work is to examine the applicability of the MK system (and in particular, the set of standard stars) in the ultraviolet, and to establish classification criteria in this spectral region.

Computerized Cone Penetration Test for Soil Classification

2008 ◽  
Vol 2053 (1) ◽  
pp. 47-64 ◽  
Author(s):  
Murad Y. Abu-Farsakh ◽  
Zhongjie Zhang ◽  
Mehmet Tumay ◽  
Mark Morvant
Keyword(s):  
Classification System ◽  
Soil Classification ◽  
Cone Penetration Test ◽  
Classification Systems ◽  
Fuzzy Classification ◽  
Classification Methods ◽  
Penetration Test ◽  
Cone Penetration ◽  
Cone Tip Resistance ◽  
Tip Resistance

Computerized MS-Windows Visual Basic software of a cone penetration test (CPT) for soil classification was developed as part of an extensive effort to facilitate the implementation of CPT technology in many geotechnical engineering applications. Five CPT soil engineering classification systems were implemented as a handy, user-friendly, software tool for geotechnical engineers. In the probabilistic region estimation and fuzzy classification methods, a conformal transformation is first applied to determine the profile of soil classification index (U) with depth from cone tip resistance (qc) and friction ratio (Rf). A statistical correlation was established in the probabilistic region estimation method between the U index and the compositional soil type given by the Unified Soil Classification System. Conversely, the CPT fuzzy classification emphasizes the certainty of soil behavior. The Schmertmann and Douglas and Olsen methods provide soil classification charts based on cone tip resistance and friction ratio. However, Robertson et al. proposed a three-dimensional classification system that is presented in two charts: one chart uses corrected tip resistance (qt) and friction ratio (Rf); the other chart uses qt and pore pressure parameter (Bq) as input data. Five sites in Louisiana were selected for this study. For each site, CPT tests and the corresponding soil boring results were correlated. The soil classification results obtained using the five different CPT soil classification methods were compared.

Yoruba Disease Classifications for Planning in Health Care

1983 ◽  
Vol 4 (2) ◽  
pp. 117-122 ◽  
Author(s):  
William R. Brieger ◽  
Jayashree Ramakrishna ◽  
Joshua D. Adeniyi
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Classification System ◽  
Training Programs ◽  
Classification Systems ◽  
Disease Classification ◽  
General Point ◽  
Primary Health ◽  
Illness And Disease ◽  
Point Of Departure

An understanding of local concepts of illness and disease that underlie disease classification systems is essential for designing culturally relevant training programs in primary health care. Prior to training personnel in primary health care in Idere, Nigeria, residents were interviewed revealing that two main groups of disease exist. Generally, arun is serious, chronic and contagious, while aisan represents temporary indispositions. When given seventeen conditions to classify, respondents clearly demarked five as arun and five as aisan while the remainder fell in a grey area in between. Ironically, malaria which is a dangerous disease to young children, was classified as aisan. The disease classification system is being used as a general point of departure for discussion during training. Concerning training on the specific diseases, appropriate ideas are reinforced while others are modified all within the context of the local classification system.

scholarly journals An update on the grading of muscle injuries: a narrative review from clinical to comprehensive systems

Joints ◽  
2016 ◽  
Vol 04 (01) ◽  
pp. 039-046 ◽  
Author(s):  
Alberto Grassi ◽  
Alberto Quaglia ◽  
Gian Canata ◽  
Stefano Zaffagnini
Keyword(s):  
Prognostic Value ◽  
Muscle Injury ◽  
Clinical Signs ◽  
Classification Systems ◽  
Soccer Players ◽  
Muscle Injuries ◽  
Mri Findings ◽  
Professional Soccer ◽  
Magnetic Resonance Imaging Mri ◽  
Comprehensive Classification

Muscle injuries are recognized to be among the most frequent injuries occurring in the sporting and athletic population, and they account for more than 30% of all injuries in professional soccer players. Despite their considerable frequency and impact, there is still a lack of uniformity in the categorization, description and grading of muscle injuries.Dozens of systems based on clinical signs, ultrasound imaging (US) appearance or magnetic resonance imaging (MRI) findings have been proposed over the years. Most of them are three-grade systems that take into account pain, ROM limitation, swelling and hematoma, hypoechoic or hyperintense areas on US or MRI, and muscle gap or tendon involvement; however, they still lack evidence-based prognostic value. Recently, new comprehensive classification systems have been proposed, with the aim of developing uniform muscle injury terminology and giving each severity grade prognostic value.The systems that combine detailed MRI and US features with the clinical presentation, such as the Munich Muscle Injury Classification, the ISMuLT classification, and the British Athletic Classification, if used extensively, could improve the diagnosis, prognosis and management of muscle injuries.

scholarly journals Fractures of the Lateral Process of the Talus: A New Classification Based on CT

2021 ◽  
Author(s):  
Yuchuan Wang ◽  
Yanbin Zhu ◽  
Xiangtian Deng ◽  
Zhongzheng Wang ◽  
Siyu Tian ◽  
...  
Keyword(s):  
Classification System ◽  
Intraobserver Reliability ◽  
Kappa Statistics ◽  
Type I ◽  
New Classification ◽  
Concomitant Injuries ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Lateral Process ◽  
Comprehensive Classification

Abstract Background: The common classifications of the fractures of the lateral process of the talus（LTPFs）are based on radiographs and may underestimate the complexity of LTPF, therefore, requiring a comprehensive classification based on CT(Computed tomography) scan. The aim of this study is to propose a such classification system, and to evaluate its reliability and reproducibility.Methods: On the basis of the most widely recognized classifications of Hawkins as well as McCrory-Bladin, we proposed a new and comprehensive classification based on CT scan for the LTPF. We retrospectively reviewed 42 patients involving LTPF. All fractures were classified according to Hawkins, McCrory-Bladin and new proposed classification system by three surgeons. The analysis of interobserver and intraobserver agreements was done using kappa statistics.Results: This new classification included two types based on presence of concomitant injuries or not, with type I consisting of three subtypes and type II of five subtypes. Interobserver and intraobserver reliability of the new classification system were almost perfect (κ=0.846 and 0.823, respectively)，showing a higher interobserver and intraobserver reliability compared to the Hawkins classification (κ=0.737 and 0.689, respectively) as well as McCrory-Bladin classification (κ=0.748 and 0.714, respectively). Conclusion: This new classification system for the LTPF based on CT is a comprehensive classification considering concomitant injuries. It is more reliable and reproducible and can potentially become a useful instrument for decision making of treatment options for LTPFs. Further studies on the evaluation of their clinical relevance (especially the long-term outcome) are warranted.

Sign in / Sign up

Export Citation Format

Share Document