Gustilo open fracture

• he most commonly used classification system for Open fractures. Created by Ramon Gustilo and Anderson, then further expanded by Gustilo, Mendoza, and Williams.

• This system uses the amount of energy, the extent of soft-tissue injury and the extent of contamination for determination of fracture severity.

• Progression from grade 1 to 3C implies a higher degree of energy involved in the injury, higher soft tissue and bone damage and higher potential for complications. Important to recognize that grade 3C fracture implies vascular injury as well.

Classification

grade I:• Wound less than 1 cm with

minimal soft tissue injury• Wound bed is clean• Fracture is usually a simple

transverse, short oblique fracture, with minimal comminution

Grade II:• Wound is greater than 1 cm

with moderate soft tissue injury

• Fracture is usually a simple transverse, short oblique fracture, with minimal comminution

Grade III• Fractures that involve

extensive damage to the soft tissues, including muscle, skin and neurovascular structures

• Often accompanied by a high-velocity injury or a severe crushing component

Special patterns classified as Type III:

• Open segmental fracture, irrespective of the size of the wound

• Gunshot wounds -high velocity and short-range shotgun injuries

• Open fracture with neurovascular injury

• Farm injuries, with soil contamination, irrespective of the size of the wound

• Traumatic amputations• Open fractures over 8 hours old• Mass casualties; eg, war and

tornado victims

Grade IIIA• >10cm long• highly contaminated• Severe soft tissue injury

with cruching, but wound soft tissue coverage is possible

• Usually comminuted

 Grade IIIB• >10cm long• highly contaminated• Very severe soft tissue

injury usually requiring reconstructive surgery for coverage

• May be severely comminuted

Grade IIIC• >10cm long• highly contaminated• Very severe soft tissue

injury with vascular injury requiring repair; usually requires reconstructive surgery for coverage

• May be severely comminuted