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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Gustilo-Anderson Classification

Key Points Open fractures are associated with high rates of morbidity and mortality The most common fractures that are open are tibial, phalangeal, forearm, ankle, and metacarpal Check the overlying area for skin breakdown or tissue loss All patients with open fractures need antibiotic cover and up-to-date tetanus vaccination Timely surgical management, with input from plastic and vascular surgery as required, will ensure optimal outcomes.

An early study conducted by Gustilo in showed that primary closures with prophylactic antibiotics of Type I and type II fractures reduced the risk of infection by By visiting this site you agree to the foregoing terms and conditions. Grade 3 injuries can be further subdivided by the degree of periosteal and vascular injury and soft tissue loss:.

Despite its limited interobserver agreement [ 519 ], good but imperfect prognostic ability, and somewhat dated treatment algorithms, no other classification is superior in terms of its popularity and common use, and because the Gustilo-Anderson schema correlates well with the risk of infection and other complications [ 52123 ].

Furthermore, Webb et al. Thank you for rating! The retrospective part of the study evaluated open fractures of long bones in patients to determine the impact of primary versus secondary closure, use of primary internal fixation, and routine use of antibiotics in the treatment algorithm of open long-bone fractures.

It is important to recognize that a Gustilo score of grade 3C implies vascular injury as well as bone and connective-tissue damage. This comprehensive classification is better andersonn for research than routine clinical use, but it should remind the clinician that a thorough evaluation of each of the included tissues is essential for an adequate understanding of a fracture wound.


The sickness impact profile: Thank you for updating your details. 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. A coefficient of agreement for nominal scales. L8 – 10 years in practice.

HPI – The patient reported an injury of the right forefoot her foot caught in the wheel of the quadbike and she presented 10 hours after the incident. Indian Journal of Orthopaedics. The Gustillo classification does not take into account the viability and death of soft tissues over time which can affect the outcome of the injury. The results of a survey of two hundred and forty-five gudtilo surgeons. A simple summary in how this can help to guide management is: Broad-spectrum antibiotic cover should be administered, as per local guidelines, and a tetanus vaccination is required if the patient is not fully up-to-date with their vaccination.

There is general agreement that more severe open fractures have a worse clinical prognosis for infection, nonunion, and other complications, although the magnitudes of these findings vary depending on numerous clinical factors [ 718 ]. Please classificatioh to add comment.

The relationship between time to surgical debridement and incidence of infection after open high-energy lower extremity trauma. This, along with the exposure of bone and deep tissue to the environment, leads to increased risk of infection, wound complications, and nonunion [ 122831 ].

Delayed primary closure historically has been used, especially for Type III fractures, but consideration for earlier closure has been reported.

Gustilo open fracture classification – Wikipedia

An additional influence is the ability of the host to combat infection, based on both systemic and local factors. The grading system is used to guide management of compound fractures, with classfication grade injuries associated with higher risk of complications.

J Am Acad Orthop Surg.


National Center for Biotechnology InformationU. They are caused by various mechanisms, ranging from low-energy twisting forces to high-energy motor vehicle crashes or penetrating injuries gun shots, blasts. Any evidence of contamination should be assessed for and documented — marine, agricultural, and sewage contamination is of the highest importance. Therefore, inGustilo subclassified Type III fractures into A, B, and C with the aim of guiding the treatment of open fractures, communication and research, and to predict outcomes.

Retrieved from ” https: 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.

Thorough evaluation of the entire patient is essential clwssification focusing on the injured leg.

Gustilo open fracture classification

Because open fractures andersoon be underclassified on initial evaluation in the emergency department, many investigators agree that definitive classification that is, the classification that will drive the eventual treatment decisions of open fractures is best made in the operating room [ 3132223 ].

Support Radiopaedia and see fewer ads. Because much of the literature on the subject of open fractures uses the Gustilo-Anderson classification or a variant of it, it is important to know whether the classification is reliable.

J Bone Joint Surg Br. This system uses the amount of energy, the extent of soft-tissue injury and the extent of contamination for determination of fracture severity. Log in Sign up.

Open fractures are, by definition, contaminated; therefore, anerson use of antibiotics is therapeutic, not prophylactic, and is fundamental to the care of patients with these injuries [ 14 ].

This article has been cited by other articles in PMC. Whether the timing of wound debridement, soft tissue coverage, and bone have any benefits on the outcome is also questionable. The Gustilo-Anderson classification system remains the preferred system for categorizing open fractures. Problems in management of type III severe open fractures: