Describes open fractures by severity of injury
| Type |
Description |
| I |
Wound <1 cm |
| II |
Wound 1–10 cm |
| IIIa |
Wound >10 cm with adequate local soft tissue coverage |
| IIIb |
Wound >10 cm without adequate local coverage. Requires free flap soft tissue reconstruction |
| IIIc |
Associated arterial injury |
Caveats
- Any grossly-contaminated wound (e.g. agricultural, aquatic, sewage) is automatically Grade III
- Any high-energy injury (e.g. gunshot wound) is automatically Grade III
Problems with this classification:
- Early assessment is unreliable: Best graded intra-operatively. Poor inter-observer reliability in early clinical assessment.
- Deep tissue injury is not well-established: Visible skin-level injury is not always indicative of underlying soft tissue injury severity.
- Soft tissue quality is not considered: There is also no clear differentiation between clean and straight lacerations vs. wounds irregular edges and necrotic/non-viable tissue.
- Local anatomy is not considered: Does not take local soft tissue coverage into account. For example, the tibial shaft has far thinner soft tissue coverage compared to femoral shaft.