Tscherne classification

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The Tscherne classification is a system of categorization of soft tissue injuries. [1]

Contents

Classification

Tscherne GradeOpen soft tissue injuriesClosed fractures
0Fr. C 0 - No or minor soft-tissue injury from a simple fracture due to indirect trauma
IFr. O 1 - Skin lacerated by bone fragment. No or minimal contusion to the skinFr. C 1 - Superficial contusion or abrasion to the skin
IIFr. O 2 - Skin laceration with circumferential skin or soft-tissue contusion and moderate contaminationFr. C 2 - Deep contaminated abrasions with skin or muscle contusion from direct trauma
IIIFr. O 3 - Extensive soft-tissue damage with major vessel or nerve injuryFr. C 3 - Extensive skin contusion with destruction of subsutaneous tissue avulsion or muscle destruction
IVFr. O 4 - Subtotal and total amputations with separation of all important anatomical structures

Reliability

The intraobserver (observations at two different times by the same person) agreement for Tscherne classification is 85%; while for inter-observer agreement is 65%. [2]

History

This classification system was developed by Harald Tscherne and Hans-Jörg Oestern in 1982 at the Hannover Medical School (Hanover, Germany) to classify both open and closed fractures. This classification system is based on the physiological concept that the higher the kinetic energy imparted on the bone, the higher the kinetic energy imparted on the soft tissue. It also serves as a tool to guide management and to predict clinical outcomes. It also serves as a communication tool in research and in clinical presentations. [2]

See also

Related Research Articles

Hydrostatic shock

Hydrostatic shock is the controversial concept that a penetrating projectile can produce a pressure wave that causes "remote neural damage", "subtle damage in neural tissues" and/or "rapid incapacitating effects" in living targets. It has also been suggested that pressure wave effects can cause indirect bone fractures at a distance from the projectile path, although it was later demonstrated that indirect bone fractures are caused by temporary cavity effects.

Compartment syndrome Condition in which increased pressure results in insufficient blood supply

Compartment syndrome is a condition in which increased pressure within one of the body's anatomical compartments results in insufficient blood supply to tissue within that space. There are two main types: acute and chronic. Compartments of the leg or arm are most commonly involved.

Dual-energy X-ray absorptiometry

Dual-energy X-ray absorptiometry is a means of measuring bone mineral density (BMD) using spectral imaging. Two X-ray beams, with different energy levels, are aimed at the patient's bones. When soft tissue absorption is subtracted out, the bone mineral density (BMD) can be determined from the absorption of each beam by bone. Dual-energy X-ray absorptiometry is the most widely used and most thoroughly studied bone density measurement technology.

Injury Physiological wound caused by an external source

Injury, also known as physical trauma, is damage to the body caused by an external force. This may be caused by accidents, falls, hits, weapons, and other causes. Major trauma is injury that has the potential to cause prolonged disability or death. In 2013, 4.8 million people world-wide died from injuries, up from 4.3 million in 1990. More than 30% of these deaths were transport-related injuries. In 2013, 367,000 children under the age of five died from injuries, down from 766,000 in 1990. Injuries are the cause of 9% of all deaths, and are the sixth-leading cause of death in the world.

Back injury

Back injuries result from damage, wear, or trauma to the bones, muscles, or other tissues of the back. Common back injuries include sprains and strains, herniated discs, and fractured vertebrae. The lumbar spine is often the site of back pain. The area is susceptible because of its flexibility and the amount of body weight it regularly bears. It is estimated that low-back pain may affect as much as 80 to 90 percent of the general population in the United States.

Bone fracture Physical damage to the continuity of a bone

A bone fracture is a medical condition in which there is a partial or complete break in the continuity of a bone. In more severe cases, the bone may be broken into several pieces. A bone fracture may be the result of high force impact or stress, or a minimal trauma injury as a result of certain medical conditions that weaken the bones, such as osteoporosis, osteopenia, bone cancer, or osteogenesis imperfecta, where the fracture is then properly termed a pathologic fracture.

Distal radius fracture Fracture of the radius bone near the wrist

A distal radius fracture, also known as wrist fracture, is a break of the part of the radius bone which is close to the wrist. Symptoms include pain, bruising, and rapid-onset swelling. The wrist may be broken for life. The ulna bone may also be broken.

External fixation

External fixation is a surgical treatment wherein rods are screwed into bone and exit the body to be attached to a stabilizing structure on the outside of the body. It is an alternative to internal fixation, where the components used to provide stability are positioned entirely within the patient's body. It is used to stabilize bone and soft tissues at a distance from the operative or injury focus. They provide unobstructed access to the relevant skeletal and soft tissue structures for their initial assessment and also for secondary interventions needed to restore bony continuity and a functional soft tissue cover.

Lisfranc injury Type of fracture/dislocation injury of the foot

A Lisfranc injury, also known as Lisfranc fracture, is an injury of the foot in which one or more of the metatarsal bones are displaced from the tarsus.

Calcaneal fracture Medical condition

A calcaneal fracture is a break of the calcaneus. Symptoms may include pain, bruising, trouble walking, and deformity of the heel. It may be associated with breaks of the hip or back.

Open fracture Medical condition

An open fracture, also called a compound fracture, is a type of bone fracture in orthopedics that is frequently caused by high energy trauma. It is a bone fracture associated with a break in the skin continuity which can cause complications such as infection, malunion, and nonunion. Gustilo open fracture classification is the most commonly used method to classify open fractures, to guide treatment and to predict clinical outcomes. Advanced trauma life support is the first line of action in dealing with open fractures and to rule out other life-threatening condition in cases of trauma. Cephalosporins are generally the first line of antibiotics. The antibiotics are continued for 24 hours to minimize the risk of infections. Therapeutic irrigation, wound debridement, early wound closure and bone fixation are the main management of open fractures. All these actions aimed to reduce the risk of infections.

Gunshot wound Form of physical trauma sustained from the discharge of arms or munitions

A gunshot wound (GSW) is physical trauma caused by a projectile from a firearm. Damage may include bleeding, broken bones, organ damage, infection of the wound, loss of the ability to move part of the body, and in more severe cases, death. Damage depends on the part of the body hit, the path the bullet follows through the body, and the type and speed of the bullet. Long-term complications can include lead poisoning and post-traumatic stress disorder (PTSD).

Mandibular fracture Medical condition

Mandibular fracture, also known as fracture of the jaw, is a break through the mandibular bone. In about 60% of cases the break occurs in two places. It may result in a decreased ability to fully open the mouth. Often the teeth will not feel properly aligned or there may be bleeding of the gums. Mandibular fractures occur most commonly among males in their 30s.

The Gustilo open fracture classification system is the most commonly used classification system for open fractures. It was created by Ramón Gustilo and Anderson, and then further expanded by Gustilo, Mendoza, and Williams.

Femoral fracture Medical condition

A femoral fracture is a bone fracture that involves the femur. They are typically sustained in high-impact trauma, such as car crashes, due to the large amount of force needed to break the bone. Fractures of the diaphysis, or middle of the femur, are managed differently from those at the head, neck, and trochanter

Tibial plateau fracture Medical condition

A tibial plateau fracture is a break of the upper part of the tibia (shinbone) that involves the knee joint. Symptoms include pain, swelling, and a decreased ability to move the knee. People are generally unable to walk. Complication may include injury to the artery or nerve, arthritis, and compartment syndrome.

Pilon fracture Medical condition

A pilon fracture, is a fracture of the distal part of the tibia, involving its articular surface at the ankle joint. Pilon fractures are caused by rotational or axial forces, mostly as a result of falls from a height or motor vehicle accidents. Pilon fractures are rare, comprising 3 to 10 percent of all fractures of the tibia and 1 percent of all lower extremity fractures, but they involve a large part of the weight-bearing surface of the tibia in the ankle joint. Because of this, they may be difficult to fixate and are historically associated with high rates of complications and poor outcome.

Proximal humerus fracture Break of the upper part of the bone of the arm

A proximal humerus fracture is a break of the upper part of the bone of the arm (humerus). Symptoms include pain, swelling, and a decreased ability to move the shoulder. Complications may include axillary nerve or axillary artery injury.

Tibia shaft fracture Medical condition

Tibia shaft fracture is a fracture of the proximal (upper) third of the tibia. Due to the location of the tibia, it is frequently injured. Thus it is the most commonly fractured long bone in the body.

Single photon absorptiometry is a measuring method for bone density invented by John R. Cameron and James A. Sorenson in 1963.

References

  1. Tscherne H, Oestern HJ (1982). "A new classification of soft-tissue damage in open and closed fractures". Unfallheilkunde. 85 (3): 111–5. PMID   7090085.
  2. 1 2 David A, Ibrahim; Alan, Swenson; Adam, Sassoon; Navin D, Fernando (14 July 2016). "Classifications In Brief: The Tscherne Classification of Soft Tissue Injury". Clinical Orthopaedics and Related Research. 475 (2): 560–564. doi:10.1007/s11999-016-4980-3. PMC   5213932 . PMID   27417853.