The Gustilo open fracture classification system is the most commonly used classification system for open fractures. It was created by Ramón Gustilo and Anderson, and then further expanded. Open Fracture: Gustilo classification. Open fractures have been classified by Gustilo as follows, with higher numbers indicating more severe injuries. Open fractures, also called compound fractures, are severe injuries to bones. These injuries almost always require surgery. Learn more.

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AO principles of fracture management, Volume 1. The results of a survey of two hundred and forty-five orthopaedic surgeons.

Open Fractures

Clsasification fracture with adequate soft tissue coverage of a fractured bone despite extensive soft tissue laceration or flaps, or high-energy trauma gunshot and farm injuries regardless of the size of the wound [5] [6].

This is due to much of the criteria being at risk of observer errors, and is a known liability classkfication this scaling system. Another critical limitation is that the surface injury does not always reflect the amount of deeper tissue damage and the Gustilo-Anderson classification does not account for tissue viability and tissue necrosis, which tend to evolve with time after more gudtilo injuries.

J Bone Joint Surg Am. Exposed fracture with arterial damage that requires repair. Retrospective and prospective analyses. Requires free tissue flap or rotational flap coverage. No vascular injury is identified.

The grading system is used to guide management of compound fractures, with higher grade injuries associated with higher risk of complications. Although the principles of management for open tibial fractures are constant, the path to the final result may vary. History Open fractures usually are high-energy injuries. Figure 3 — Ensure to photograph any open fracture, to avoid repeated uncovering of dressings for inspection. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: These slides subsequently were evaluated by 22 orthopaedic surgeons eight attending orthopaedic surgeons and 14 orthopaedic residents.


The key findings were that qnderson closure without primary internal fixation and prophylactic antibiotics for Type I and Type II open fractures reduced the risk of infection as much as Such classifications have been aneerson use for some time [ 29 ]; however, it is the Gustilo-Anderson classification that has become the most commonly used system for classifying open fractures.

Special categories in Type III were gunshot injuries, any open fracture caused by a farm injury, and any open fracture with accompanying vascular injury requiring repair [ 16 ]. Treatment of open fractures of the shaft of the tibia.

Grade 3 injuries can be further subdivided by the degree of periosteal and vascular injury and soft tissue loss:.

Gustilo Classification

Duration of preventive antibiotic administration for open extremity fractures. Many of the principles outlined by Gustilo et al. Management of open fractures and subsequent complications. Check for errors and try again. The gjstilo for plastic surgery input should be identified early, to allow both specialties to be present at the first operation and therefore avoid multiple procedures.

Simple fx pattern with minimal comminution.

The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes.

See Clin Orthop Relat Res. Gustilo initially does not recommend early wound closure and early fixation for Grade III fractures.

Despite the overall improvement in outcome after open fractures, the variable outcomes among different patterns of open fractures with differing severities prompted the development of grading systems that classify them based on increasing severity of the associated soft tissue injuries.

Okike K, Bhattacharyya T. Like many classification systems, the purpose of the Gustilo-Anderson schema is to provide a prognostic framework that guides treatment and facilitates communication among surgeons and clinician-scientists.

Unable to process the form. Meanwhile, early internal fixation and primary closure of the wound in Type III fractures have a greater risk of getting osteomyelitis. Gustilo and Anderson then prospectively followed more than patients. Whilst any fracture can become open, the most common fractures are tibial, phalangeal, forearm, ankle, and metacarpal.


The variability among individuals and their interpretation of the Gustilo-Anderson classification [ 16 ] results in a spectrum of injuries having too much overlap [ 5 ], possibly owing to the observer error [ 19 ]. This article has been corrected. Given that the classification system [ 1617 ] is easy to use and has prognostic and therapeutic implications, it is of value, but treatment recommendations based on the classification [ 1617 ] should be interpreted with caution owing to its limitations regarding interobserver reliability [ 519 ].

Infection The grade of open fracture, condition of the soft tissues, degree of contamination and the thoroughness of surgical debridement will have influence on the risk of infection. Gustilo and Anderson originally recommended against early fracture fixation for many Type III injuries. The AO classification of fracture wound severity provides a grading system for injuries of each of the skin Imuscles and tendons MTand neurovascular NVeach of which is divided into five degrees of severity.

The surgeon must anticipate this possibility, monitoring the patient carefully and considering fasciotomy during open fracture debridement.

Gustilo open fracture classification – Wikipedia

Local antibiotic therapy for severe open fractures: The measurement of observer agreement for categorical classificcation. Limitations The Gustilo-Anderson classification is widely used [ 6 ], and is the basic language with which many investigators communicate the results of open fracture treatment [ 5 ]. Severe open fractures of the tibia. How important is this topic for clinical practice? Management of open fractures and subsequent complications.

Besides, the number of the underlying medical illnesses of the patient also affects the outcome. To comprehensively measure prognosis, outcome measures such as the Classificztion Impact Profile [ 2 ] can be used for more accuracy. There are many discussions regarding the inter-observer reliability of this classification system.