NISSSA Score of McNamara et al for Open Fracture of the Lower Extremity

nerve

sensate

no major nerve injury

0

dorsal

deep or superficial peroneal nerve, femoral nerve injury

1

plantar partial

tibial nerve injury

2

plantar complete

sciatic nerve injury

3

ischemia

none

good to fair pulses, no ischemia

0

mild <= 6 hours

reduced pulses but perfusion normal

1

moderate <= 6 hours

no pulse; prolonged capillary refill; Doppler pulses present

2

severe <= 6 hours

pulseless, cool, ischemic, no Doppler pulses

3

mild > 6 hours

2

moderate > 6 hours

4

severe > 6 hours

6

soft tissue

low

minimal to no contusion, no contamination

0

medium

moderate injury, low velocity gunshot wound, moderate contamination, minimal crush

1

high

moderate crush, deglove, high velocity gunshot, injury may require soft tissue flap, considerable contamination

2

severe

massive crush, farm injury, severe deglove, severe contamination

3

skeletal

low energy

spiral fracture, oblique fracture, no or minimal displacement

0

medium energy

transverse fracture, minimal comminution, small caliber gunshot wound

1

high energy

moderate displacement, moderate comminution, high velocity gunshot wound, butterfly fragments

2

severe energy

segmental, severe comminution, severe bone loss

3

shock

normotensive

always > 90 mm Hg systolic

0

transient hypotension

transient

1

persistent hypotension

persistent hypotension despite fluids

2

age

< 30 years

young

0

30 – 50 years

middle age

1

> 50 years

older

2