A segmental compound fracture of the tibia with 12 cm skin wound along with crushed tissue and contamination but with adequate soft tissue coverage occurring in a farm is classified as:
Correct Answer: Type III A
Description: Ans: C (Type IIIA) Ref: Rockwood and Green 's Fractures in Adults, 7th EditionExplanation:Compound fractures are classified under the Gustilo Anderson Classification of Open FracturesTYPE ILow-energy clean woundcl cm with minimal soft tissue injury and comminutionTYPE IIWound >1 cm with moderate soft-tissue damage and fracture comminution.Soft tissue component is often defined as disruption <10 cm and without periosteal strippingTYPE IIIThe Type III open fractures include higher energy injuries. Substantial soft tissue injury, with periosteal stripping, has occurred, and a crush component is typically present.The fracture pattern, such as segmental comminution, reflects the higher forces imparted.TYPE IIIaFracture wound >10 cm with crushed tissue and contamination but usually with adequate soft tissue coverageTYPEIIIbFracture wound >10 cm with crushed tissue and contamination having inadequate soft tissue cover associated with periosteal stripping and often requiring transfer of vascularized tissue for soft tissue coverageTYPE IIIcOpen fractures associated with a major vascular injury that requires repair for limb salvageNotes:Type I fractures are those with minimal soft tissue injury.Skin lacerations are less than or equal to one cm, and are clean, without evidence of deep muscle crushing or foreign debris contamination.Additionally, the underlying fracture pattern must he consistent with a low energy injury.Examples include spiral diaphyseal fractures or rotational periarticular injuries.Higher energy fracture patterns, such as segmental or bending wedge fractures, should be considered as higher grade open fractures.Injury being a farm injury is suggestive of contamination. Hence this case would go into Type IIIA.In the event of segmental comminution being present, it would be classified as Type IIIB since segmental comminution is suggestive of more extensive soft tissue and periosteal injury irrespective of the size of the wound.
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