Gustilo Classification

Tiffany J. Pan

John R. Fowler

INTRODUCTION

Classification system for open fractures proposed by Dr Ramon Gustilo and Dr John Anderson in 1976¹
Primary study aim was the treatment and prevention of infection in open fractures.
Classification system was developed for the prospective study arm.

EVALUATION

History
- Mechanism of injury (high vs low energy)
- Environment to which the bone was exposed (clean vs contaminated or farm injury)
Physical examination (Figure 41.1)
- Size of traumatic wound
- Exposed bone
- Degree of soft tissue damage
- Vascular injury
- Neurologic examination
Imaging
- Plain films to assess fracture pattern
- May require advanced imaging for periarticular fractures or suspected vascular injury
Classification
- Original classification described by Gustilo and Anderson¹ in 1976
  - Type I—clean wound less than 1 cm long
  - Type II—wound longer than 1 cm without significant soft tissue injury
  - Type III—open segmental fracture or open fracture with significant soft tissue injury including traumatic amputation with special categories as follows:
    - Gunshot injuries
    - Farm injuries
    - Vascular injury requiring repair
- Current complete classification (Table 41.1)

FIGURE 41.1 Type IIIA open distal radius fracture with periosteal stripping.

ACUTE MANAGEMENT