According to the Gustilo-Anderson classification, a Type III open fracture is further subdivided into three grades. Which of the following is NOT a criterion for Type IIIA fracture?

Explanation

## Gustilo-Anderson Classification: Type III Subtypes **Key Point:** Type III open fractures are subdivided into IIIA, IIIB, and IIIC based on soft tissue injury severity and vascular status, not fracture pattern alone. ### Type IIIA Characteristics - Adequate soft tissue coverage of the fractured bone despite the open wound - High-energy mechanism with extensive soft tissue damage - Fracture may be simple or comminuted - Periosteal stripping may be present - No vascular injury requiring repair ### Type IIIB Characteristics - **Extensive soft tissue loss with periosteal stripping** - **Requires flap reconstruction for coverage** - Usually associated with severe contamination - High infection risk ### Type IIIC Characteristics - **Vascular injury requiring repair** (arterial injury) - Regardless of soft tissue damage severity - Highest amputation risk **High-Yield:** The key distinguishing feature between IIIA and IIIB is the **need for flap reconstruction**. IIIA has adequate soft tissue coverage despite the injury; IIIB requires flap coverage due to extensive tissue loss. **Clinical Pearl:** Type IIIC is defined by **vascular injury**, not soft tissue damage—a Type IIIA with an arterial injury becomes Type IIIC. | Type | Soft Tissue Coverage | Vascular Injury | Flap Needed | |------|---------------------|-----------------|-------------| | IIIA | Adequate | No | No | | IIIB | Inadequate | No | Yes | | IIIC | Any | Yes | Possibly |