Gustilo open fracture classification

The Gustilo open fracture classification system is the most commonly used classification system for Open fractures. It was created by Ramon Gustilo and Anderson, and then further expanded by Gustilo, Mendoza, and Williams.^[1]^[2]^[3]

This system uses the amount of energy, the extent of soft-tissue injury and the extent of contamination for determination of fracture severity. 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. Important to recognize that grade 3C fracture implies vascular injury as well. ^[4]

Classification

Gustilo open fracture Classification
Gustilo Grade	Definition
I	Open fracture, clean wound, wound <1 cm in length
II	Open fracture, wound > 1 cm but < 10 cm in length^[4] without extensive soft-tissue damage, flaps, avulsions
III	Open fracture with extensive soft-tissue laceration (>10 cm^[4]), damage, or loss or an open segmental fracture. This type also includes open fractures caused by farm injuries, fractures requiring vascular repair, or fractures that have been open for 8 hr prior to treatment
IIIA	Type III fracture with adequate periosteal coverage of the fracture bone despite the extensive soft-tissue laceration or damage
IIIB	Type III fracture with extensive soft-tissue loss and periosteal stripping and bone damage. Usually associated with massive contamination. Will often need further soft-tissue coverage procedure (i.e. free or rotational flap)
IIIC	Type III fracture associated with an arterial injury requiring repair, irrespective of degree of soft-tissue injury.

Reliability

There are many discussions regarding the inter-observer reliability of this classification system. Different studies show inter-observer reliability of approximately 60% (ranging from 42 to 92%).^[5]^[6]

Another important issue of this classification system is the ability to predict outcome. For this purpose, other classification systems, like Mangled Extremity Severity Score (MESS) and Limb Salvage Index (LSI) have been devised.^[7]^[8]

Gustilo type I open fracture

Gustilo type II open fracture

References

↑ Rüedi, etc. all; Thomas P. Rüedi; Richard E. Buckley; Christopher G. Moran (2007). AO principles of fracture management, Volume 1. Thieme. p. Page 96. ISBN 3-13-117442-0.
↑ Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: Retrospective and prospective analyses. J Bone Joint Surg Am. 1976;58:453–8
↑ Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: A new classification of type III open fractures. J Trauma. 1984;24:742–6.
1 2 3 http://www.orthobullets.com/trauma/1003/gustilo-classification
↑ Brumback RJ, Jones AL. Interobserver agreement in the classification of open fractures of the tibia: The results of a survey of two hundred and forty-five orthopaedic surgeons. J Bone Joint Surg Am. 1994;76:1162–6
↑ Cross WW, Swiontkowski M. Treatment principles in the management of open fractures.Indian J Orthop. 2008 Oct-Dec; 42(4): 377–386.
↑ Johansen K, Daines M, Howey T, Helfet D, Hansen ST., Jr Objective criteria accurately predict amputation following lower extremity trauma. J Trauma. 1990;30:568–72
↑ MacKenzie EJ, Bosse MJ, Kellam JF, Burgess AR, Webb LX, Swiontkowski MF, et al., editors. Factors influencing the decision to amputate or reconstruct after high-energy lower extremity trauma. J Trauma. 2002;52:641–9

Orthopaedic eponyms

Medical eponyms

Fractures	Bankart's fracture Barton's fracture Bennett's fracture Bosworth fracture Chance fracture Chopart's fracture-dislocation Colles' fracture Dupuytren's fracture Duverney fracture Essex-Lopresti fracture Galeazzi fracture Gosselin fracture Holstein–Lewis fracture Holdsworth fracture Hutchinson's fracture Hoffa fracture Hume fracture Jefferson fracture Jones fracture Lisfranc fracture Maisonneuve fracture Malgaigne's fracture Monteggia fracture Moore's fracture Pipkin fracture-dislocation Plafond fracture Pott's fracture Rolando fracture Segond fracture Shepherd's fracture Smith's fracture Stieda fracture Tillaux-Chaput avulsion fracture Wagstaffe-Le Fort avulsion fracture Volkmann avulsion fracture

Classifications	Bado classification Danis–Weber classification Denis classification Evans-Jensen classification Ficat classification Frykman classification Garden classification Gartland classification Gruen zone Gustilo open fracture classification Haruguchi classification Hawkin's classification Herbert classification Herscovici classification Ideberg classification Jupiter and Mehne classification Lauge-Hansen classification Le Fort fracture of skull Loder classification Mayfield classification Milch classification Neer classification Pipkin classification Pauwel's classification Riseborough and Radin classification Ruedi-Allgower classification Salter–Harris fracture Schatzker classification of tibia plateau fractures Tile classification Schatzker classification of olecranon fractures Sanders classification Seddon classification Seinsheimer classification Schenck classification Teisen classification Tscherne classification Thompson and Epstein classification Vancouver classification Wassel classification Winquist and Hansen classification Young-Burgess classification

Procedures	Akin osteotomy Bankart repair Broström procedure Brunelli procedure Cotrel–Dubousset instrumentation Cunningham Shoulder Reduction Darrach's procedure Darrah procedure Evans technique Girdlestone's Procedure Keller procedure Kocher manoeuvre Krukenberg procedure Latarjet procedure Mumford procedure Ponseti method Swanson's Arthroplasty Tommy John surgery Weil's Osteotomy Weaver–Dunn procedure Zadek's procedure

Anatomy	Gerdy's tubercle Guyon's Canal Harrison's groove Haversian canal Humphrey's ligament Lisfranc joint Lisfranc ligament Lister's tubercle Martin-Gruber Anastomosis Schmorl's nodes Volkmann's canals

CPRs	Harris Hip Score Kocher criteria Mirel's Score Rowe Score

Clinical signs	Andersson lesion Baastrup's sign Bouchard's nodes Boutonniere deformity Coopernail's sign Codman triangle Destot's sign Frankel's sign Heberden's node Kanavel's sign Larrey's sign Trendelenburg gait

Clinical examination	Allis test Apley grind test Apley scratch test Barlow's maneuver Clarke's test Cozen's test Cotton test Durkan's test Finkelstein's test Froment's sign Jobe's test Kapandji score Gaenslen's test Galeazzi test Gerber's test Hawkins–Kennedy test Hubscher's maneuver Lachman test Lasègue's sign McMurray test Mulder's sign Neer impingement sign O'Brien's test Ober's test Ortolani test Patrick's test Phalen maneuver Simmonds' test Schober's test Speed's test Thomas test Thompson test Tinel sign Trendelenburg's sign Yergason's test Waddell's signs Watson's test Wilson test

Congenital conditions	Albers-Schonberg disease Albright's hereditary osteodystrophy Antley–Bixler syndrome Apert syndrome Beals syndrome Bechterew's Bruck syndrome Camurati–Engelmann disease Catel–Manzke syndrome Cole carpenter syndrome Conradi–Hünermann syndrome Currarino syndrome Ehlers–Danlos syndrome Eiken syndrome Ellis–van Creveld syndrome Erlenmeyer flask deformity Fairbanks disease Hajdu–Cheney syndrome Jansen's metaphyseal chondrodysplasia Kashin–Beck disease Klippel–Feil syndrome Klippel–Trénaunay–Weber syndrome Kniest dysplasia Lobstein syndrome Madelung's deformity Maffucci syndrome Marfan syndrome Marie-Strümpell disease Marshall syndrome Marshall–Smith syndrome McCune–Albright syndrome Melnick–Needles syndrome Morton's toe Ollier disease Rett syndrome Rubinstein–Taybi syndrome Scheuermann's disease Schwartz–Jampel syndrome Silver–Russell syndrome Teunissen–Cremers syndrome Trevor disease Wiedemann syndrome

Acquired conditions	Baker's cyst Bankart lesion Barré–Liéou syndrome Blount's disease Brodie abscess Chandler's disease De Quervain syndrome Dupuytren's contracture Ewing's sarcoma Freiberg disease Garre's sclerosing osteomyelitis Gorham's disease Haglund's deformity Hill–Sachs lesion Iselin's disease Kashin–Beck disease Kienbock's disease Köhler disease Legg–Calvé–Perthes syndrome Morton's neuroma O'Donoghue's triad Osgood–Schlatter disease Paget's disease of bone Panner disease Perthes Lesion Preiser disease Sever's disease Stener lesion Sudeck's atrophy Tietze syndrome Volkmann's contracture

Orthopedic implants	Austin Moore prosthesis Baksi's prosthesis Charnley prosthesis Denis Browne bar Ender's nail Grosse-Kempf nail Harrington rod Herbert screw Kirschner wire Kuntscher nail Moore's pin Neer's prosthesis Rush nail Schanz screw Seidel nail Smith Peterson nail Steinmann pin Swanson prosthesis Talwalkar nail Thompson prosthesis

Orthopaedic instruments	Bryant's traction Charnley Retractor Darrach elevator Faraboeuf forceps Gigli saw Hohmann retractor Ilizarov apparatus Inge retractor Jungbluth forceps Matta forceps Taylor Spatial Frame Thomas splint Verbrugge forceps Volkmann retractor Weber forceps

Surgical approaches	Hardinge lateral approach to the hip Moore or Southern posterior approach to the hip Smith-Petersen anterior approach to the hip Watson-Jones anterolateral approach to the hip

Radiographic signs	Baumann's angle Blumensaat's line Bohler's angle Cobb angle Fairbank's changes Gilula's Lines Harris lines Hilgenreiner's line Kellgren-Lawrence grading scale Klein's line Loosers zone Pauwel's angle Perkin's line Shenton's Line Southwick angle Thurstan Holland sign Trethowan's sign Terry-Thomas sign

Radiographic projections	Judet view Broden's view

Principles	Wolff's law Hueter-Volkmann law Charley's principles of three-point fixation

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Gustilo open fracture classification

Classification

Reliability

References

See also