Classification

Again, several classification systems are available but the classic system that is simple and aids in treatment decisions is the Gustilo classification that reports three major types and considers mechanism, degree of soft tissue involvement, fracture pattern, and level of contamination.6

• Type I: Wound is less than 1 cm long. No sign of crush injury. Usually a clean puncture type wound and signifies an "inside/out" injury where a spike of bone punctures the skin. Little comminution of the fracture is present.

• Type II: Wound is larger than 1 cm, but no extensive soft tissue damage or flap exists. May be mild contamination, comminution, and may show signs of mild crush injury.

• Type III: There is extensive soft tissue damage with a high degree of contamination. Usually a result of high-energy trauma resulting in significant comminution and instability. Type III fractures are further classified into three subgroups.

• III-A: There remains adequate soft tissue covering of the bone regardless of soft tissue damage.

• III-B: Extensive soft tissue injury with massive contamination, muscle loss, fracture comminution, and periosteal stripping. After debridement a local or free flap is required to cover resultant exposed bone.

• III-C: Involves any open fracture associated with arterial injury that must be repaired regardless of soft tissue injury.

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