Gustilo Classification
Tiffany J. Pan
John R. Fowler
INTRODUCTION
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Classification system for open fractures proposed by Dr Ramon Gustilo and Dr John Anderson in 19761
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Primary study aim was the treatment and prevention of infection in open fractures.
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Classification system was developed for the prospective study arm.
EVALUATION
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History
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Mechanism of injury (high vs low energy)
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Environment to which the bone was exposed (clean vs contaminated or farm injury)
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Physical examination (Figure 41.1)
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Size of traumatic wound
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Exposed bone
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Degree of soft tissue damage
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Vascular injury
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Neurologic examination
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Imaging
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Plain films to assess fracture pattern
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May require advanced imaging for periarticular fractures or suspected vascular injury
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Classification
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Original classification described by Gustilo and Anderson1 in 1976
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Type I—clean wound less than 1 cm long
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Type II—wound longer than 1 cm without significant soft tissue injury
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Type III—open segmental fracture or open fracture with significant soft tissue injury including traumatic amputation with special categories as follows:
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Gunshot injuries
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Farm injuries
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Vascular injury requiring repair
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Current complete classification (Table 41.1)
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FIGURE 41.1 Type IIIA open distal radius fracture with periosteal stripping. |
ACUTE MANAGEMENT
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Initiate antibiotics as soon as possible
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Infection rate increases if antibiotics are delayed >3 hours from the time of injury.
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Continue antibiotics until 3 to 5 days after the final surgical procedure.
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Types I and II
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Gram-positive organism coverage
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First-generation cephalosporin
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Fluoroquinolone if allergic
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Type III
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Gram-positive and Gram-negative organism coverage
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First-generation cephalosporin + aminoglycoside
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