Suedkamp et al developed a scale for describing the extent of injury associated with fracture of an extremity. This can help distinguish between different levels of severity in patients with traumatic injury. The authors are from the Freie Universitat Berlin, Universitatsklinikum Rudolf Virchow (Berlin) and the University of Hannover in Germany.
Parameters:
(1) fracture type (AO-ASIF)
(2) bone loss
(3) soft tissue
(3a) skin wound or contusion
(3b) skin defect
(3c) deep soft tissue injury (muscles, tendons, ligaments, joint capsule)
(3d) amputation
(4) ischemia or compartment syndrome
(5) nerves
(5a) palmar/plantar sensation
(5b) finger/toe motion
(6) foreign body
(7) bacteriologic smear (Gram stain)
(8) onset of treatment (only if soft tissue score > 2)
|
Parameter |
Finding |
Points |
|---|---|---|
|
AO-ASIF fracture type |
type A (simple, with 2 pieces) |
1 |
|
|
type B (wedge, with 3 pieces) |
2 |
|
|
type C (complex, multifragmented) |
4 |
|
bone loss |
none |
0 |
|
|
< 2 cm |
1 |
|
|
>= 2 cm |
2 |
|
skin wound or contusion |
none |
0 |
|
|
< 0.25 circumference |
1 |
|
|
0.25 – 0.5 circumference |
2 |
|
|
0.5 – 0.75 circumference |
3 |
|
|
> 0.75 circumference |
4 |
|
skin defect |
none |
0 |
|
|
< 0.25 circumference |
1 |
|
|
0.25 – 0.5 circumference |
2 |
|
|
0.5 – 0.75 circumference |
3 |
|
|
> 0.75 circumference |
4 |
|
deep soft tissues |
none |
0 |
|
|
< 0.25 circumference |
1 |
|
|
0.25 – 0.5 circumference |
2 |
|
|
0.5 – 0.75 circumference |
3 |
|
|
> 0.75 circumference |
6 |
|
amputation |
none |
0 |
|
|
subtotal guillotine |
20 |
|
|
subtotal crush |
30 |
|
ischemia or compartment syndrome |
none |
0 |
|
|
incomplete |
10 |
|
|
complete, < 4 hours |
15 |
|
|
complete, 4 – 8 hours |
20 |
|
|
complete, > 8 hours |
25 |
|
palmar or plantar sensation |
yes |
0 |
|
|
none |
8 |
|
finger or toe motion |
yes |
0 |
|
|
none |
8 |
|
foreign body |
none |
0 |
|
|
single |
1 |
|
|
multiple |
2 |
|
|
massive |
10 |
|
bacteriologic smear |
negative |
0 |
|
|
aerobe, 1 morphotype |
2 |
|
|
aerobe, mixed |
3 |
|
|
anaerobe |
2 |
|
|
mixed aerobe and anaerobe |
4 |
|
onset of treatment |
(soft tissue score 0 to 2) |
0 |
|
|
soft tissue score > 2) and onset of treatment < 6 hours |
0 |
|
|
(soft tissue score) > 2 and onset of treatment < 6 hours |
1 |
|
|
(soft tissue score) > 2 and onset of treatment < 6 hours |
3 |
where:
• For amputations, there was no point assignment for total guillotine or crush amputations.
• Being able to distinguish aerobic from anaerobic bacteria based on Gram stain appearance could be challenging soon after the injury but might be possible if an infection was established and there was some clinical information about gas or myonecrosis.
total score =
= SUM(points for all parameters)
soft tissue subscore =
= (points for skin wound or contusion) + (points for skin defect) + (points for deep soft tissue injury) + (points for amputation)
Interpretation:
• minimum score: 1 (if any fracture occurred), 2 (for a simple open fracture)
• maximum score: 108
• The higher the score, the more severe the fracture.
|
Total Score |
Corresponding Tscherne Open Fracture |
|---|---|
|
2 to 3 |
O I |
|
4 to 19 |
O II |
|
20 to 69 |
O III |
|
>= 70 |
O IV |
Specialty: Surgery, orthopedic, Emergency Medicine, Critical Care, Surgery, general
