Classification of type III (severe) open fractures relative to treatment and results.

Abstract

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%.