It is important to recognize that a Gustilo score of grade 3C implies vascular injury as well as bone and connective-tissue damage.
Different studies have shown inter-observer reliability of approximately 60% (ranging from 42% to 92%),[7][8] representing poor-to-moderate agreement of scale grading between health-care professionals.
The Gustillo classification does not take into account the viability and death of soft tissues over time which can affect the outcome of the injury.
[5] For more comprehensive prognosis purposes other classification systems, such as the Sickness Impact Profile (as a health status measure),[5] Mangled Extremity Severity Score (MESS) and Limb Salvage Index (LSI) (decision to amputate or salvage a limb), have been devised by Dr Shanmuganathan Rajasekaran.
Meanwhile, early internal fixation and primary closure of the wound in Type III fractures have a greater risk of getting osteomyelitis.