Gustilo Anderson Classification of Open Fractures

M. Nizam .E

Classification of open fractures : Important because it allows comparison of results between surgeons and in scientific publications. Gives the surgeon guidelines for prognosis and permits us to make some statements about methods of treatment

Classification of Open Fractures

Type I Skin opening of 1 cm or less, quite clean. Most likely from inside to outside. Minimal muscle contusion. Simple transverse or short oblique fractures. Type II Laceration more than 1 cm long, with extensive soft tissue damage, flaps, or avulsion. Minimal to moderate crushing component. Simple transverse or short oblique fractures with minimal comminution. Type III Extensive soft tissue damage including muscles, skin, and neurovascular structures. Often a high-velocity injury with severe crushing component. Type III A Extensive soft tissue laceration, adequate bone coverage. Segmental fractures, gunshot injuries. Type III B Extensive soft tissue injury with periosteal stripping and bone exposure. Usually associated with massive contamination. Type III C Vascular injury requiring repair.
Source: Gustilo, R.B.; et al. J Trauma 24:742746, 1984.

A type I wound is : By a low-energy injury Less than 1 cm long . Caused by the bone piercing from the inside outward rather than by a penetrating injury. Bacterial contamination is usually low. Minimal or no muscle damage.

A type II wound is : Greater than 1 cm in length A moderate amount of soft tissue damage owing to a higher-energy injury . Outside-to-inside injuries. Necrotic muscle may be present, but the amount of debridement required is minimal to moderate. Usually confined to one compartment. The soft tissue stripped from bone is none to minimal Wound closure without skin grafts or local flaps should be possible.

A type III wound results from : A high-energy injury Outside-to-inside injury Extensive wound & muscle devitalization. The fracture is widely displaced or comminuted. Contamination also increases the likelihood of infection and subsequent complications.

A type IIIA open fracture is Limited stripping of the periosteum and soft tissues from bone. Bone coverage does not present any major problems. There may be loss of skin, but there is adequate muscle and soft tissue coverage over bone, tendon, and neurovascular bundles

A type IIIB open fracture is Extensive stripping of soft tissues and periosteum from bone. Devitalization or loss of soft tissues usually requires a local flap or free tissue transfer for coverage of exposed bone and/or neurovascular bundles. A type IIIC open fracture is A major vascular injury requiring repair for salvage of the extremity.