Classification of type III (severe) open fractures relative to treatment and results.
Severe type III open fractures were subtyped according to the differences in prognosis for sepsis, amputation, and treatment: IIIA (adequate soft-tissue coverage of bone with extensive soft-tissue laceration or flaps), IIIB (extensive soft-tissue loss with periosteal stripping and bone exposure), and IIIC (arterial injury requiring repair). Analysis of 303 open fractures revealed a sepsis rate of 0% in type I, 2.5% in type II, and 13.7% in type III. The rate of amputation was 18.7%, and the rate of nonunion was 18.5% in type III open fractures. Type IIIA, IIIB, and IIIC open fractures had sepsis rates of 5%, 28%, and 8%, and amputation rates of 2.5%, 5.6%, and 25%, respectively. The overall wound sepsis rate in the 303 open fractures was 4.4%, and the nonunion rate was 8.6%.
Gustilo
R B
RB
Department of Orthopedic Surgery, Hennepin County Medical Center, Minneapolis, MN 55415.
Gruninger
R P
RP
Davis
T
T
D000671:Amputation, Surgical; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001419:Bacteria / Q000302:isolation & purification; D016025:Bone Transplantation; D002986:Clinical Trials as Topic; D003646:Debridement; D005592:Fracture Fixation; D005597:Fractures, Open / Q000145:classification / Q000150:complications / Q000628:therapy*; D005599:Fractures, Ununited / Q000453:epidemiology; D006801:Humans; D011446:Prospective Studies; D011897:Random Allocation; D013524:Surgical Flaps; D007507:Therapeutic Irrigation; D014946:Wound Infection / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology
D000900:Anti-Bacterial Agents