Long et al reported a grading system for gunshot-related fractures of the femoral diaphysis. The authors are from the Dr. Martin Luther King and Charles Drew Medical Center in Los Angeles.
Parameters:
(1) entrance and exit wound size
(2) devitalized muscle
(3) radiographic findings
Wound Size
Devitalized Muscle
Grade
< 2 cm
none
I
2 - 5 cm
none
II
> 5 cm
present
III
2 - 5 cm
present
III
where:
• There is no category of < 2 cm with devitalized muscle.
• Grade I injuries are low energy wounds.
Radiographic Change
Grade
narrow tract of metal, bone and/or air; comminution with several small and large bone fragments
I
severe comminution or segmental bone loss; muscle swelling; infiltration of metal, bone and/or air over wide area
II
large defect in skin and subcutaneous tissue + Grade II changes
III
where:
• Severe comminution is defined as the presence of > 10 large and > 10 small bone fragments.
• Segmental bone loss is defined as an area of bone > 7 cm in length that cannot be reconstructed after reassembling the bone fragments.
The final grade is the maximum grade based on the clinical and radiographic assessment.
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