Table 1 The ganga hospital open injury severity score

Covering Structures: Skin and Fascia

Wound with no skin loss and not over the fracture site

No skin loss; not over the fracture site.

1

Wound with no skin loss and over the fracture site

No skin loss; over the fracture site.

2

Wound with skin loss and not over the fracture site

Skin loss; not over the fracture site.

3

Wound with skin loss and over the fracture site

Skin loss; over the fracture site.

4

Functional Tissues: Musculotendinous and Nerve Units

Partial injury to Musculotendinous

Partial injury to musculotendinous unit.

1

Complete but repairable Musculotendinous injury

Complete but repairable injury to musculotendinous unit.

2

Irreparable Musculotendinous injury or complete injury to posterior tibial nerve

Irreparable musculotendinous injury, partial loss of compartment, or complete injury to posterior tibial nerve.

3

Loss of one compartment of the Musculotendinous unit

Loss of one compartment of the musculotendinous unit.

4

Loss of two or more compartments or subtotal amputation

Loss of two or more compartments, or subtotal amputation.

5

Skeletal Structures: Bones and Joints

Transverse/oblique fracture or butterfly fragment < 50% circumference

Transverse/oblique fracture or butterfly fragment less than 50% of circumference.

1

Large butterfly fragment > 50% circumference

Large butterfly fragment greater than 50% of circumference.

2

Comminuted or segmental fracture without bone loss

Comminuted or segmental fracture with no bone loss.

3

Bone loss < 4 cm

Bone loss of less than 4 cm.

4

Bone loss > 4 cm

Bone loss of more than 4 cm.

5

Co-morbidities: Add 2 points for each condition present

Injury to debridement time interval greater than 12 h

Injury with a debridement time interval greater than 12 h.

2

Sewage or organic contamination or farmyard injuries

Injuries involving sewage or organic contamination, or farmyard injuries.

2

Age greater than 65 years

Age of the patient greater than 65 years.

2

Drug-dependent diabetes mellitus or cardio-respiratory disease leading to increased anesthetic risk

Drug dependency, diabetes mellitus, or cardio-respiratory disease increasing anesthetic risk.

2

Polytrauma involving chest or abdomen with injury severity score > 25 or fat embolism

Polytrauma involving the chest or abdomen with an injury severity score greater than 25 or fat embolism.

2

Hypotension with systolic blood pressure < 90 mmHg at presentation

Hypotension with systolic blood pressure less than 90 mmHg at presentation.

2

Another injury to the same limb or compartment syndrome

Another injury to the same limb or compartment syndrome.

2

Decision Guidelines

Limb salvage is advisable for a score ≤ 14

N/A

Amputation is advisable for a score ≥ 17

N/A

Scores of 15 and 16 fall into a “gray zone” where decision depends on patient-specific factors

N/A