Fracture

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Classification Current preference in terminology is to use open rather than compound to denote a fracture with an overlying wound. GustilloAnderson \classification (1)
The prevalence of wound infection and nonunion increases with increasing grade of open fracture.
The Gustillo Anderson classification of open fractures looks at several aspects of the injury not just the size of the wound.
• Prescence or absence of neurovascular injury
• Degree of contamination (farmyard injuries are grade III injuries)
• Energy transfer (Degree of comminution and periosteal stripping)
• Wound dimensions
Grade I
The wound is less than 1cm long. It is usually a moderately clean puncture, through which a spike of bone has pierced the skin. There is little soft-tissue damage and no sign of crushing injury. The fracture is usually simple, transverse, or short oblique, with little comminution.
Grade II
The laceration is more than 1 cm long, and there is no extensive soft-tissue damage, flap, or avulsion. There is slight or moderate crushing injury, moderate comminution of the fracture, and moderate contamination.
Grade III
These are characterized by extensive damage to soft-tissues, including muscles, skin, and neurovascular structures, and a high degree of contamination. The fracture is often caused by high velocity trauma, resulting in a great deal of comminution and instability.
• III A – Soft tissue coverage of the fractured bone is adequate
• III B – Extensive injury to, or loss of soft tissue, with periosteal stripping and exposure of bone, massive contamination, and severe comminution of the fracture. After debridement and irrigation a local or free flap is needed for coverage.
• III C – Any open fracture that is associated with an arterial injury that must be repaired, regardless of the degree of soft tissue injury.
The definitive grade should be assigned in theatre after thorough debridement.
The risk of infection in an open fracture depends on the

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