title: Complex extremity fractures following high energy injuries: the limited value of existing classifications and a proposal for a treatment-guide.
abstract: Complex extremity fractures have been described as demanding and associated with an increased risk of complications. Since a treatment-guided classification is not currently available, we recommend a new assessment for complex extremity fractures, categorising them into low, moderate and high risk depending on several fracture-related comorbidities. In our experience, the degree of soft-tissue damage and the overall injury severity are the most critical determinants in deciding whether primary definitive fracture stabilisation is possible or should be delayed. Low-risk complex extremity fractures can be managed according to classic fracture principles, whereas these principles may have limited value in moderate-risk complex extremity fractures. High-risk complex extremity fractures in the polytrauma setting require thorough assessment. In selected cases, primary amputation is a life-saving alternative. We present a new treatment guide taking parameters of local injury severity into account.
authors.affiliation: Department of Orthopaedic and Trauma Surgery, University Hospital Aachen, Aachen, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Kobbe
authors.forename: Philipp
authors.initials: P
authors.lastname: Lichte
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Pape
mesh_terms: D000671:Amputation, Surgical; D005121:Extremities / Q000098:blood supply / Q000293:injuries* / Q000601:surgery; D005593:Fracture Fixation, Internal / Q000379:methods; D050723:Fractures, Bone / Q000145:classification* / Q000150:complications / Q000601:surgery; D006801:Humans; D015601:Injury Severity Score; D009104:Multiple Trauma / Q000601:surgery*; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D017695:Soft Tissue Injuries / Q000601:surgery