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Non Fracture Classification Systems in the Upper Limb

Author: James Carmichael

Ring Avulsion Injuries

Classification based on the extent of injury as described by Urbaniak

  1. Class 1: Simple laceration with no vascular compromise
  2. Class 2: Circulation compromised requiring a vascular repair
    1. No additional tendon/nerve/bone injury
    2. Additional tendon/nerve/bone injury
  3. Class 3: Complete degloving or amputation

In General the class 2B and 3 injuries are best treated with amputation.

Mangled Extremity Severity Score

Energy of Injury
Low 1
Medium 2
High 3
Massive 4

No Ischaemia 0
Decreased pulses 1
Thready Pulses 2
Pulseless 3

Normal 0
Transient 1
Prolonged 2

<30 0

    1. 1

>50 2

Used as an aid to determine likelihood of successful limb salvage. A score of >7 is a relative contraindication to limb salvage while a score of <4 is a good prognostic factor.

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