Classification_of_Open_Injuries_Maheshwari (1).pptx

It is about classification of open injuries...orthopedics

1. Classification of Open Injuries Roll no: 81 to 100

2. Introduction • Open injuries are wounds where there is a break in the skin and underlying soft tissues. • They expose deeper tissues to the external environment. • These injuries are common in trauma, especially road traffic accidents and crush injuries.

3. Importance of Classification • Helps in assessing severity of injury. • Guides management and prognosis. • Useful for documentation and communication among healthcare professionals.

4. Basic Classification of Injuries 1. Closed injuries 2. Open injuries (focus of this presentation) Open injuries can further be classified based on mechanism, contamination, and tissue involvement.

5. Types of Open Injuries 1. Incised wound 2. Lacerated wound 3. Punctured wound 4. Crush injury 5. Avulsion injury 6. High-velocity gunshot wound

6. Incised Wound • Caused by sharp-edged objects like knife or glass. • Clean-cut edges with minimal tissue damage. • Bleeding is more due to vessel transection. • Usually associated with less infection risk.

7. Lacerated Wound • Caused by blunt trauma. • Irregular, torn wound edges. • More tissue damage and contamination. • Higher risk of infection compared to incised wounds.

8. Puncture Wound • Caused by pointed or sharp objects like nails, splinters. • Small surface wound but deep tract. • High risk of infection and retained foreign body.

9. Crush Injury • Due to compression between heavy objects. • Extensive soft tissue and muscle damage. • May cause compartment syndrome or necrosis. • Often associated with fractures.

10. Avulsion Injury • Caused by traction forces pulling tissue away from attachment. • Partial or complete detachment of skin or soft tissue. • May lead to significant bleeding and tissue loss.

11. Gunshot Wound • Caused by high-velocity projectiles. • Entry and exit wounds may be present. • Massive tissue destruction due to cavitation effect. • High contamination risk.

12. Gustilo-Anderson Classification (Overview) Most widely used classification system for open fractures. Classifies injuries based on wound size, contamination, and soft tissue damage.

13. The classification has grades I, II, III , and III is further subdivided into IIIA, IIIB, IIIC . The classification is based on wound size, soft tissue injury, contamination, and vascular injury .

14. Gustilo Type I • Clean wound <1 cm. • Simple fracture pattern. • Minimal soft tissue damage. • Usually from inside-out injury (bone piercing skin).

15. Clinical importance Relatively lower risk of infection, more amenable to early closure

16. Gustilo Type II • Wound >1 cm but <10 cm. • Moderate soft tissue damage. • No extensive muscle crushing or flap loss.

17. Clinical importance More risk than Type I, but still manageable with debridement + stabilization

18. Gustilo Type III (General) • Wound >10 cm. • Extensive soft tissue destruction and contamination. • Requires flap or graft for coverage. • Divided into IIIA, IIIB, and IIIC.

19. Clinical importance Highest risk category; needs more complex management

20. Gustilo Type IIIA • Severe soft tissue injury but adequate coverage possible. • Bone not exposed after debridement. • Usually from high-energy trauma.

21. Clinical importance Even though soft tissues are badly injured, coverage is still possible without flap

22. Gustilo Type IIIB • Extensive soft tissue loss with bone exposure. • Requires flap coverage. • Usually with periosteal stripping and contamination.

23. Clinical importance These often cannot be closed primarily; need staged soft-tissue reconstruction

24. Gustilo Type IIIC • Any open fracture with associated arterial injury needing repair. • Worst prognosis among all types.

25. Clinical importance Vascular injury presence makes it much more urgent and higher risk, even if soft-tissue damage is not extreme

26. Mechanism-Based Classification 1. Low-energy injuries – fall, cut. 2. High-energy injuries – road accidents, gunshot. 3. Crush or blast injuries – massive tissue destruction.

27. By Contamination 1. Clean wounds – minimal contamination. 2. Contaminated wounds – dirt, oil, debris present. 3. Infected wounds – established infection signs like pus, odor.

28. By Time of Presentation • Fresh wounds – within 6 hours. • Delayed wounds – after 6 hours, higher infection risk.

29. By Tissue Involvement • Skin only – superficial. • Soft tissue and muscle involvement. • Bone involvement – open fracture.

30. Other Classifications / Modifications & Adjuncts Because of limitations in Gustilo, other schemes and modifications exist. Here are a few: Unified Classification of Open Fractures AO / OTA soft-tissue injury classification Tscherne / Oestern classification

31. Unified Classification of Open Fractures : Attempts to combine Gustilo + OTA (Orthopaedic Trauma Association) elements to improve reliability. It considers 5 categories: skin injury, muscle injury, arterial injury, contamination, bone loss

32. AO / OTA soft-tissue injury classification : The AO group classifies soft-tissue damage more granularly (by muscle, skin, contamination), which can complement the fracture component.

33. Tscherne / Oestern classification : More often used for closed fractures’ soft tissue injury , but also has an “Fr. O” category for open soft tissue injuries: Fr. O1 → skin lacerated by bone fragment, minimal contusion Fr. O2 → skin laceration + circumferential soft tissue contusion & moderate contamination Fr. O3 → extensive soft-tissue damage ± vascular/nerve injury Fr. O4 → subtotal or total amputations (severe)

34. Clinical Assessment • Check size, depth, contamination, tissue viability. • Assess neurovascular status. • Rule out compartment syndrome.

35. Investigations • X-ray – to check for bone involvement. • Doppler – for vascular injury. • Culture – if wound appears contaminated.

36. Principles of Management 1. Resuscitation and stabilization. 2. Control of bleeding. 3. Thorough wound irrigation and debridement. 4. Tetanus prophylaxis. 5. Antibiotic therapy.

37. Wound Debridement • Removal of all devitalized tissue. • Preserves viable structures. • Should be done under aseptic conditions.

38. Antibiotic Therapy • Broad-spectrum antibiotics started early. • Type I & II: 1st-gen cephalosporins. • Type III: add aminoglycosides and metronidazole.

39. Wound Closure • Primary closure – only if clean. • Delayed primary closure – after 3–5 days. • Secondary closure or skin graft – if large defect.

40. Complications • Infection. • Delayed healing. • Non-union or osteomyelitis. • Compartment syndrome. • Neurovascular damage.

41. Prognosis • Depends on severity, contamination, and timing of treatment. • Early and proper management improves outcomes.

42. Summary • Open injuries vary from simple cuts to complex fractures. • Classification helps guide management. • Gustilo-Anderson classification is most commonly used.

43. Prevention • Use protective gear. • Educate on road safety. • Early medical attention after trauma.

44. Key Takeaways • Accurate classification = better management. • Early debridement and antibiotics are critical. • Always assess neurovascular integrity.

45. References Maheshwari J., Essential Orthopaedics, 6th Edition. Gustilo RB et al., JBJS, 1984.