Tscherne Classification

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

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