Ganga hospital open injury severity score - A score to prognosticate limb salvage and outcome measures in Type IIIb open tibial fractures

Background: Gustilo′s grade IIIB classification includes a wide spectrum of injuries and is limited by high inter and intra observer error rates. Methods: A trauma score for grade IIIB open tibial fractures was devised to assess injury to three components; the covering tissues, musculotendinous units and bone with the severity scale in each category from one to five. Seven co-morbid conditions known to influence the prognosis were each given a score of two and summed up. Results : Ninety six consecutive Grade IIIB open injuries of tibia were prospectively evaluated. At 3-5 year follow up, of the 88 available, final score was less than five in 6 patients (Group I), between six and ten in 48 (Group II), eleven to fifteen in 29 (Group III) and above 16 in five (Group IV). All patients in Group IV and one in Group III with score of fifteen underwent amputation. There was a significant difference (p less than 0.001) between the three groups in the requirement for flap (16.7,75&100 percent), time for union (16.3,24.9 &46.9), incidence of deep infection (0,22.9 &60.7 percent), number of surgical procedures (1.2,3.1 &6.3) and inpatient days (12.5,22.6 &59.4). A score of greater than three in any one component required special skills in management and interfered with healing of other structures. Conclusion: The scoring system was easy to apply and had a high degree of interobservor aggreement rate. This comprehensive score reliably prognosticates both limb salvage and outcome measures in severe open injuries of tibia.