Complex extremity fractures following high energy injuries: The limited value of existing classifications and a proposal for a treatment-guide

Complex extremity fractures have been described as demanding and associated with an increased risk of complications. Since a treatment-guided classification is not currently available, we recommend a new assessment for complex extremity fractures, categorising them into low, moderate and high risk depending on several fracture-related comorbidities. In our experience, the degree of softtissue damage and the overall injury severity are the most critical determinants in deciding whether primary definitive fracture stabilisation is possible or should be delayed. Low-risk complex extremity fractures can be managed according to classic fracture principles, whereas these principles may have limited value in moderate-risk complex extremity fractures. High-risk complex extremity fractures in the polytrauma setting require thorough assessment. In selected cases, primary amputation is a life-saving alternative. We present a new treatment guide taking parameters of local injury severity into account.