Probably the most frequently misunderstood part of this classification of soft tissue injury is the Type IIIC vascular injury. We are going to try hard to develop a good and consistent understanding of that.

A Type IIIC open fracture essentially means when you do your examination, there are no intact distal pulses or perfusion. At that point, when you are looking at the leg you know you have to do one of two things. Either amputate or perform a vascular repair on the spot. This is not one to observe and see if it gets infected or something else. You are in that crux of the six to eight hour time decision where you absolutely have to do something.

The classification gets a little confusing in the tibia where we have the trifurcation of three vessels distally. If two of the vessels are out - say the posterior tib is still intact and perfusing the foot - that is not a IIIC injury. The foot and the extremity distal to the fracture may still be viable. It might not do as well because two vessels are out but by definition it is not a IIIC because you are still perfusing the limb. It is only a IIIB - albeit a bad IIIB