Oestern and Tscherne Classification for Closed fractures

The classification system for closed fractures is based on the physiologic concept that the energy imparted to the bone (and the resultant fracture pattern) directly correlates with the energy transferred to the surrounding soft tissues.

tscherne classification closed fractures
GradeSoft tissue injuryFractureCompartment
C0Absent or NegligibleSimple (Spiral)Soft and/or Normal
C1Superficial abrasion or Skin contusionMedium severity (Rotational ankle fracture dislocations)Soft and/or Normal
C2Deep (contaminated) abrasion or Muscle contusionSevere (Transverse or segmental)Impending compartment syndrome
C3Extensive skin contusion, Crush injury with severe damage to underlying muscle, Morel-Lavallee lesion and/or vascular injuryComplexCompartment syndrome

This grading can aid in anticipating outcomes and optimizing appropriate treatment. Primary definitive fixation has been shown to be appropriate for lower-grade injuries, whereas staged treatment is more appropriate for higher-grade injuries. It is based largely on clinical examination.

Reference: Ibrahim DA, Swenson A, Sassoon A, Fernando ND. Classifications In Brief: The Tscherne Classification of Soft Tissue Injury. Clin Orthop Relat Res. 2017 Feb;475(2):560-564. doi: 10.1007/s11999-016-4980-3. Epub 2016 Jul 14. PMID: 27417853; PMCID: PMC5213932.

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