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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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Definitive surgical management requires debridement of the wound and the fracture site, removing all devitalised tissue present. It is designed to provide a unique, unequivocal definition of any injury and thereby, allows accurate comparison of cases.

Gustilo open fracture classification

After reviewing their initial classification of the most severe open injuries, Gustilo et al. Any evidence of contamination should be assessed for and documented — marine, agricultural, and sewage contamination is of the highest importance. The Gustilo Anderson classificationalso known as the Gustilo classificationis the most widely accepted classification system of open or compound fractures.

However newer studies have shown that early wound closure and early fixation reduces infection rates, promotes fracture healing and early restoration of function. If there is vascular compromisethis needs immediate surgical exploration by vascular surgery.

You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. The sickness impact profile: L7 – years in practice. How important is this topic for clinical practice? Wound debridement will be necessary. Articles Cases Courses Quiz.

Gustilo Classification

A simple summary in how this can help to guide management is: Indian Journal of Orthopaedics. This article has been corrected. All injuries with vascular injury. Anderon attempts by Veliskakis [ 29 ] at grading open fractures were refined by Gustilo and Anderson in [ 16 ]. There are many discussions regarding the inter-observer reliability of this classification system.


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Core Tested Community All. Another critical limitation is that the surface injury does not always reflect the amount of deeper tissue damage and the Gustilo-Anderson classification does not account for tissue viability and tissue necrosis, andreson tend to evolve with time after more severe injuries.

Usually associated with massive contamination. Host classification predicts infection after open fracture. No vascular injury is identified. What is the most appropriate Gustilo-Anderson classification of this injury? The epidemiology of open long-bone fractures.

Following suitable resuscitation and stabilisation, urgent realignment and splinting of the limb is warranted. The severity of the injuries to soft tissues, bone and neurovascular structures must be identified and used for treatment planning. The retrospective part of the study evaluated open fractures of long bones in patients to determine the impact of primary versus secondary classificwtion, use of primary internal fixation, and routine use of antibiotics in the treatment algorithm of open long-bone fractures.

Primary internal fixation in open fractures of the tibial shaft: This system uses the amount of energy, the extent of soft-tissue injury and the extent of contamination for determination of fracture severity. Problems in management of type III severe open fractures: J Bone Joint Surg Am.

However, soon after that, he recommended internal fixation devices for Type III fractures. Open tibial shaft fractures: The need for plastic surgery input should be identified early, to allow both specialties to be present at the first operation and therefore avoid multiple procedures. Perhaps because of their more severe soft-tissue injury, open fractures may have a higher incidence of compartment syndrome than that of comparable closed injuries.

Type III fractures, however, are not a homogeneous group; another study found a considerable range of infection rates among the subtypes of Type III injuries, with 1. J Am Acad Orthop Surg. Despite the overall improvement in gusti,o after open gustio, the variable outcomes among different patterns of open fractures with differing severities prompted the development of grading systems that classify them based on increasing severity of the associated soft tissue injuries.


Whilst any fracture can become open, the most common fractures are tibial, phalangeal, forearm, ankle, and metacarpal. Impaired bone healing Delay or failure of bone healing is common with open tibial fractures. This comprehensive classification is better suited 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.

Patzakis MJ, Wilkins J. Management of open tibial fractures can be challenging.

Cochrane Database Syst Rev. Many of the principles outlined by Gustilo et al. Generally, the higher the grading of Gustillo classification, the higher the rate of infection and complications; any Guistilo classification rating should still be interpreted with caution due to observer errors before any definite therapeutic plans are made.

Open Fractures – Classification – Management – TeachMeSurgery

Check for errors and try again. They categorized open injuries into the familiar three categories, anddrson on wound size, level of contamination, and osseous injury, as follows: As a widely known and relatively straightforward system, which has become the standard of classifying open fractures, the Gustilo-Anderson classification also is useful for education of residents and other trainees in the treatment of patients with orthopaedic trauma [ 19 ].

Interobserver agreement in the classification of open fractures of the tibia: 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 ]. Typically requires classfiication coverage. Thorough evaluation of anderwon entire patient is essential before focusing on the injured leg.