Complex extremity fractures following high energy injuries: the limited value of existing classifications and a proposal for a treatment-guide.

Abstract

Complex extremity fractures have been described as demanding and associated with an increased risk of complications. Since a treatment-guided classification is not currently available, we recommend a new assessment for complex extremity fractures, categorising them into low, moderate and high risk depending on several fracture-related comorbidities. In our experience, the degree of soft-tissue damage and the overall injury severity are the most critical determinants in deciding whether primary definitive fracture stabilisation is possible or should be delayed. Low-risk complex extremity fractures can be managed according to classic fracture principles, whereas these principles may have limited value in moderate-risk complex extremity fractures. High-risk complex extremity fractures in the polytrauma setting require thorough assessment. In selected cases, primary amputation is a life-saving alternative. We present a new treatment guide taking parameters of local injury severity into account.