Puncture-type injuries acquired in a contaminated environment and likely therefore to contain tetanus spores e.g. gardening injuries
Wounds containing foreign bodies
Compound fractures
Wounds or burns with systemic sepsis
Certain animal bites and scratches – although smaller bites from domestic pets are generally puncture injuries animal saliva should not contain tetanus spores unless the animal has been routing in soil or lives in an agricultural setting

high risk wounds

Any of the above and either

Heavy contamination with material likely to contain tetanus spores e.g. soil, manure
Wounds or burns that show extensive devitalised tissue
Wounds or burns that require surgical intervention that is delayed for more than six hours are high risk even if the contamination was not initially heavy

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