Open phalangeal Fracture: Duncan classification

Duncan Open Phalangeal Fracture Wound Classification
I Tidy laceration less than 1 cm in length, no soiling, no soft tissue loss or crush. Basically a puncture wound from within or without.
II Tidy laceration less than 2 cm in length, from outside in, no soiling, no soft tissue crush or loss. partial muscle laceration.
IIIA Laceration greater than 2 cm. penetrating or puncturing projectile wound. Any frankly soiled wound.
IIIB Same as III A + any periosteal elevation or stripping
IIIC Same as III B + neurovascular injury.

Final outcome is greatly influenced by the grade of injury, as reported by Duncan in a study of 75 patients (Duncan et al JHS 18A:387-394, 1993).

Results graded by Total Active Motion
Grade Excellent Good Fair Poor
I 47% 29% 24% 0%
II 37% 19% 14% 30%
IIIA 14% 52% 7% 27%
IIIB 0% 0% 3% 97%
IIIC 0% 0% 0% 100%

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