Grading is important in determining the management of open fractures:
- Minor / Grade I - small punctate wound less than 1 cm associated with low velocity trauma. Minimal soft tissue injury. No crushing. No comminution.
- Moderate / Grade II - wounds which are extensive in length and width but with relatively little soft tissue damage, and only moderate crushing or comminution.
- Major / Grade III - wounds of moderate or massive size with considerable soft tissue injury and/or foreign body contamination:
- III A - sufficient soft tissue to cover the fracture
- III B - insufficient tissue to cover the fracture; also periosteal stripping and severe comminution
- III C - arterial damage requiring repair. Degree of soft tissue damage not considered
Less than 2% wound infection in grade I; more than 10% in grade II. High velocity injuries are III B or III C although the external wound may be small.