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Soft Tissue Injury

Tsherne Type I soft tissue injury image  

Tscherne and Gotzen classification of soft-tissue injury

  • (Tsherne H, Gotzen L: Fractures with Soft Tissue Injuries. Monograph 1-58. Berlin, Springer-Verlag 1984)
  • Type 0=minimal soft-tissue damage resulting from an indirect mechanism of injury that has caused a simple bone fracture.
  • Type 1=superficial abrasion or soft-tissue contusion caused by pressure from the bone injury with a mild to moderately severe fracture pattern.
  • Type 2=deep contaminated abrasion associated with localized skin and muscle contusion, an impending compartment syndrome, and a high-energy fracture pattern.
  • Type 3=extensive skin contusion or crushing, underlying severe muscle damage, a compartment syndrome, and a severe fracture pattern.

Gustilo Classificaiton of open fractures

  • Grade I=minor open fx, <1cm, simple fx patterns
  • Grade II=1-10cm wound, simple fx patterns with minimal periosteal stripping
  • Grade III=severe soft-tissue damage, IIIA can be closed primarily, IIIB require flap, IIIC arterial injury requiring repair.

Open Fractures

  • rate of infection not changed by time to surgery (<6hours vs >7hrs but within 24hrs) in children who receive early antibiotic treatment.  (Skaggs, JBJS Am 2005;87:8)