Gustilo open fracture classification

Classification

Type I:

  • Wound less than 1 cm with minimal soft tissue injury
  • Wound bed is clean
  • Fracture is usually a simple transverse, short oblique fracture, with minimal comminution

Type II:

  • Wound is greater than 1 cm with moderate soft tissue injury
  • Fracture is usually a simple transverse, short oblique fracture, with minimal comminution

Type III:

  • Fractures that involve extensive damage to the soft tissues, including muscle, skin and neurovascular structures
  • Often accompanied by a high-velocity injury or a severe crushing component
  • Special patterns classified as Type III:
    • Open segmental fracture, irrespective of the size of the wound
    • Gunshot wounds -high velocity and short-range shotgun injuries
    • Open fracture with neurovascular injury
    • Farm injuries, with soil contamination, irrespective of the size of the wound
    • Traumatic amputations
    • Open fractures over 8 hours old
    • Mass casualties; eg, war and tornado victims
  • Subtype IIIA
    • Adequate soft tissue coverage despite soft tissue laceration or flaps or high energy trauma irrespective of the size of the wound
    • Includes segmental or severely conminuted fractures
  • Subtype IIIB
    • Extensive soft tissue lost with periosteal stripping and bony exposure
    • Usually associated with massive contamination
  • Subtype IIIC
    • Fracture in which there is a major arterial injury requiring repair for limb salvage

Explanation

Gustilo open fracture classification classifies into three major categories (types) depending on the mechanism of the injury, soft tissue damage, and degree of skeletal involvement.

Figures


Open fracture of the distal radius and ulna, Gustilo type I


Gustilo type I open fracture. Image courtesy of Doncovska.


Gutilo type II open fracture. Image courtesy of Doncovska.

Reference(s)

Provide the citation for the landmark article and recent review articles describing the classification

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