The Gustilo-Mendoza-Williams open-fracture classification separately identifies, as type IIIC, those grade III open fractures with arterial injuries that require vascular repair to restore limb viability. Gustilo et al. demonstrated a 50% risk of osteomyelitis after such injuries, with amputation (early or late) a frequent outcome (Gustilo et al. (1990) The management of open fractures. J Bone Joint Surg 72(2):299-304).
This illustration shows a severe open injury of the shaft of the lower humerus, after a high-energy motor vehicle collision. There was disruption of the brachial artery and vein and neuropraxia of the median, radial, and ulnar nerves. It would be classified as a Gustilo IIIC injury, whereas on the more comprehensive AO/OTA Fracture and Dislocation Classification it would be a 12-C3, IO4-MT4-NV4.