PMID: 6471139Aug 1, 1984Paper

Problems in the management of type III (severe) open fractures: a new classification of type III open fractures

The Journal of Trauma
R B GustiloD N Williams

Abstract

Between 1976-1979, 87 Type III open fractures (in 75 patients) were treated at the Hennepin County Medical Center. Factors leading to increased morbidity in Type III fractures were: massive soft-tissue damage; compromised vascularity; severe wound contamination; and marked fracture instability. This study demonstrates, because of varied severity and prognosis, that the current designation of Type III open fracture is too inclusive. We recommend, therefore, that Type III open fractures be divided, in order of worsening prognosis, into three subtypes. Type IIIA--Adequate soft-tissue coverage of a fractured bone despite extensive soft-tissue laceration or flaps, or high-energy trauma irrespective of the size of the wound. Type IIIB--Extensive soft-tissue injury loss with periosteal stripping and bone exposure. This is usually associated with massive contamination. Type IIIC--Open fracture associated with arterial injury requiring repair. Wound sepsis in the three subtypes were: Type IIIA, 4%, IIIB, 52%; and IIIC, 42%; while amputation rates were, respectively, 0%, 16%, and 42%. Only two patients developed osteomyelitis, and 12 patients had delayed or nonunions. Five patients died, all as a result of multisystem trauma. The bacteri...Continue Reading

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May 17, 2017·MMW Fortschritte der Medizin·Alexander T HaugPeter Biberthaler
Mar 30, 2017·Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS·Filippo BorianiUmraz Khan
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Jul 1, 1995·The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons·A N AcelloN M Pachuda
Feb 27, 2009·Injury·Yusuf OztürkmenMustafa Caniklioğlu
May 5, 2009·The Journal of Bone and Joint Surgery. American Volume·Douglas Bell, Elizabeth Pedersen
Mar 4, 2008·The Journal of Bone and Joint Surgery. American Volume·Jonathan Agner ForsbergFrancis Xavier McGuigan
May 1, 1993·The Journal of Hand Surgery·R W DuncanE F Meydrech
Dec 25, 2016·Biomaterials·Benjamin M GeilichThomas J Webster
Feb 15, 2017·Revista Brasileira De Ortopedia·Mário Yoshihide KuwaeFrederico Barra de Moraes
Feb 16, 2017·The Journal of the American Academy of Orthopaedic Surgeons·Oscar A DuyosFrancisco Lopez-Gonzalez
Mar 4, 2011·Foot & Ankle Specialist·Gareth N HillPalanisamy Ramesh
Feb 22, 2012·Foot & Ankle International·Brent WiersemaDana Musapatika
Oct 27, 2017·Plastic and Reconstructive Surgery·John T StranixJamie P Levine
Sep 23, 2017·Journal of Orthopaedic Trauma·Brendan R Southam, Michael T Archdeacon
Sep 23, 2017·Journal of Orthopaedic Trauma·Paul Toogood, Theodore Miclau
Oct 21, 2017·Journal of Orthopaedic Trauma·Joey P JohnsonRoman A Hayda
Aug 9, 2017·Journal of Orthopaedic Trauma·Geoffrey S MarecekJackson Lee
Sep 25, 2003·Journal of Orthopaedic Trauma·Harrison B SolomonW Andrew Eglseder
Dec 3, 2005·The Journal of Bone and Joint Surgery. American Volume·David G StewartD L Skaggs
Apr 22, 2004·Journal of Orthopaedic Research : Official Publication of the Orthopaedic Research Society·Steve W N UengJui-Hsun Weng
May 29, 2003·Clinical Orthopaedics and Related Research·Edward C Yang, Jesse Eisler
Mar 21, 2000·Plastic and Reconstructive Surgery·S A BrownL Scott Levin
Feb 4, 2010·The Journal of Bone and Joint Surgery. American Volume·Sreevathsa BoraiahDavid E Asprinio
Feb 11, 2018·European Journal of Orthopaedic Surgery & Traumatology : Orthopédie Traumatologie·Michael SchlumbergerTobias Roth
Aug 31, 2012·The Journal of Bone and Joint Surgery. British Volume·J BatesW J Harrison
Sep 7, 2017·World Journal of Orthopedics·Jason B AnariKeith D Baldwin
Jul 30, 2014·The Cochrane Database of Systematic Reviews·Vrisha MadhuriPrathap Tharyan
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Jun 18, 2002·Hospital Medicine·D P Forward, C G Moran
Jun 12, 2018·Journal of the American Veterinary Medical Association·Kirk A MuñozSheilah A Robertson
Jul 4, 2018·The Cochrane Database of Systematic Reviews·Zipporah Iheozor-EjioforJulie Bruce
Jun 12, 2018·Journal of Orthopaedic Trauma·Shaun F SteebyBrett D Crist
Nov 29, 2011·Journal of Biomedical Materials Research. Part B, Applied Biomaterials·Dustin L Williams, J William Costerton
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Sep 25, 2018·Journal of Orthopaedic Trauma·Cyrus CaroomAbdul Hamood
Mar 19, 2011·Clinical Orthopaedics and Related Research·Michael PalmerDaniel Altman
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Jan 21, 2000·Journal of Pediatric Orthopedics·D L SkaggsV T Tolo
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Mar 15, 2011·Pain·Stephen T WegenerLEAP study group
Oct 2, 2018·Journal of Orthopaedic Research : Official Publication of the Orthopaedic Research Society·Stefanie M ShielsJoseph C Wenke
May 18, 2006·Journal of Orthopaedic Research : Official Publication of the Orthopaedic Research Society·Lutz ClaesPeter Augat
Jun 17, 2006·Journal of Orthopaedic Research : Official Publication of the Orthopaedic Research Society·Thomas KälickeStephan Arens
Oct 5, 2006·Journal of Orthopaedic Research : Official Publication of the Orthopaedic Research Society·Steve W N UengShih-Jung Liu
Mar 14, 2007·Clinical Orthopaedics and Related Research·Sanjeev Kakar, P Tornetta
Dec 19, 2018·The Journal of Bone and Joint Surgery. American Volume·Guang H Yim, Joseph T Hardwicke
Jan 1, 1988·Journal of Orthopaedic Research : Official Publication of the Orthopaedic Research Society·M MacMillanL Hendeles
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Apr 12, 2008·Journal of Orthopaedic Research : Official Publication of the Orthopaedic Research Society·Lorraine E HarryJagdeep Nanchahal
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Feb 14, 2013·Journal of the Royal Army Medical Corps·J ArcherJ Perry
Apr 20, 2010·Journal of the Royal Army Medical Corps·Jon C ClasperP Hill
Apr 28, 2005·The Journal of Bone and Joint Surgery. British Volume·C J ToplissR M Atkins
Mar 31, 2010·Orthopedics·Michael S Hughes, Jeffrey O Anglen
Aug 5, 2010·The Journal of Trauma·Daniel R PossleySkeletal Trauma Research Consortium
Aug 4, 2010·Plastic and Reconstructive Surgery·Patricia B Burns, Kevin C Chung
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Jul 11, 2006·Clinical Orthopaedics and Related Research·Alexander LernerMichael Soudry
Feb 25, 2006·The Journal of Bone and Joint Surgery. British Volume·Peter V GiannoudisC Roberts
Oct 3, 2006·The Journal of Bone and Joint Surgery. British Volume·S RajasekaranS Rajasabapathy
Nov 1, 2006·The Journal of Bone and Joint Surgery. British Volume·R EkholmS Ponzer
Apr 28, 2007·The Journal of Bone and Joint Surgery. British Volume·A C WattsC M Robinson
Dec 7, 2007·The Journal of Bone and Joint Surgery. American Volume·S J MorganRaffi Gurunluoglu
May 3, 2008·The Journal of Bone and Joint Surgery. British Volume·J Aderinto, J F Keating
Feb 5, 2009·The Journal of Bone and Joint Surgery. British Volume·S RajasekaranS R Sabapathy
Jun 3, 2009·The Journal of Bone and Joint Surgery. American Volume·Michael S ShulerThomas J Moore
Apr 2, 2010·The Journal of Bone and Joint Surgery. British Volume·Philipp N StreubelWilliam M Ricci
Sep 11, 2010·Clinical Orthopaedics and Related Research·Philipp N StreubelMichael J Gardner
Sep 20, 2011·The Journal of Trauma·Clinton K MurrayPrevention of Combat-Related Infections Guidelines Panel
Aug 3, 2011·The Journal of Trauma·Arul RamasamyJon C Clasper
Jan 6, 2012·The Journal of Bone and Joint Surgery. British Volume·J G Penn-BarwellJoseph C Wenke
Sep 28, 2017·Health Economics Review·Harm HoekstraStefaan Nijs
Sep 14, 2018·The Journal of Trauma and Acute Care Surgery·Jordan R WlodarczykMargaret M Moore
Apr 25, 2012·The Journal of Bone and Joint Surgery. British Volume·A SoniPeter V Giannoudis
May 10, 2012·Clinical Orthopaedics and Related Research·Paul H Kim, Seth S Leopold
Sep 20, 2012·ANZ Journal of Surgery·Michael WagelsDavid R Theile
Nov 29, 2012·The Journal of Bone and Joint Surgery. British Volume·P A L FosterS Britten
Aug 10, 2013·The Journal of Trauma and Acute Care Surgery·David V FelicianoRobert C McIntyre
Sep 3, 2013·The Bone & Joint Journal·N D ClementCharles M Court-Brown
Mar 21, 2006·Journal of the American Podiatric Medical Association·Deepak JoshiYadu Lal
May 24, 2014·Journal of Orthopaedic Trauma·Jesse T TorbertRobert OʼToole
May 23, 2015·Journal of Biomedical Materials Research. Part B, Applied Biomaterials·Daniel L CavanaughRohan A Shirwaiker
May 28, 2019·International Orthopaedics·Deepak JainHarpal S Selhi
Jan 31, 2017·JBJS Reviews·Zachary R ZimmerSamir Mehta
Oct 20, 2019·International Orthopaedics·Reem A KaramiAmir E Ibrahim
Apr 19, 2019·The Journal of the American Academy of Orthopaedic Surgeons·Justin SieblerMatthew Mormino
Jan 2, 2020·European Journal of Orthopaedic Surgery & Traumatology : Orthopédie Traumatologie·Gianluca CantonLuigi Murena
Dec 2, 2006·Physical Therapy·Kristin R ArcherMichael J Bosse
Jan 16, 2020·Journal of Orthopaedic Trauma·Jonah Hebert-DaviesSean E Nork
Dec 21, 2006·Journal of the Royal Army Medical Corps·D E HinsleyJon C Clasper
Dec 21, 2018·Journal of Orthopaedic Trauma·Louis R LewandowskiTrauma Infectious Disease Outcomes Study Group
Mar 10, 2018·Journal of Trauma Nursing : the Official Journal of the Society of Trauma Nurses·Kathryn Samai, Antonia Vilella
Dec 5, 2006·The Journal of Bone and Joint Surgery. American Volume·Kanu Okike, Timothy Bhattacharyya
Mar 20, 2008·The Journal of Bone and Joint Surgery. American Volume·Adam Starr
Mar 27, 2001·Journal of Orthopaedic Trauma·A SkoogS Ponzer
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May 3, 2007·The Journal of Bone and Joint Surgery. American Volume·L X WebbLEAP study group