Closed Fractures The Oestern and Tscherne classification for closed fractures Oestern and Tscherne classification of soft tissue injury in closed fractures Grade 0 Minimal soft tissue damage Indirect injury to limb (torsion) Simple fracture pattern Grade 1 Superficial abrasion or contusion Mild fracture pattern Grade 2 Deep abrasion Skin or muscle contusion Severe fracture pattern Direct trauma to limb Grade 3 Extensive skin contusion or crush injury Severe damage to underlying muscle Compartment syndrome Subcutaneous avulsion Open Fractures The Oestern and Tscherne classification for open fractures uses wound size, level of contamination, and fracture pattern to grade open fractures The Oestern and Tscherne classification for open fractures Grade I Open fractures with a small puncture wound without skin contusion Negligible bacterial contamination Low-energy fracture pattern Grade II Open injuries with small skin and soft tissue contusions Moderate contamination Variable fracture patterns Grade III Open fractures with heavy contamination Extensive soft tissue damage Often, associated arterial or neural injuries Grade IV Open fractures with incomplete or complete amputations