Background: Gustilo Anderson III B/C open tibial fractures are more difficult to .. Tong D, Ji F, Zhang H, Ding W, Wang Y, Cheng P, et al. The Gustilo Anderson classification, sometimes referred to as the Gustilo classification is the most widely accepted classification system of open (or compound)  Missing: y ‎| ‎Must include: ‎y. Abridged version. Type I. wound ≤1 cm, minimal contamination or muscle damage. Type II. wound cm, moderate soft tissue injury. Type IIIA. wound usually.


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Despite this, the Gustilo-Anderson classification has prognostic implications [ 6gustilo y anderson ] with complication rates increasing as the severity of the injury increases [ 618 ]. Given that the classification system [ 1617 ] is easy to use and has prognostic and therapeutic implications, it is of value, but treatment recommendations based on the classification [ 1617 ] should be interpreted with caution owing to its limitations regarding interobserver reliability [ 519 ].

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 ].

Gustilo-Anderson Classification

A study of open fractures showed an overall infection rate of 4. In the original study by Gustilo and Anderson, an overall infection rate of 2. Type III fractures, however, are not a homogeneous group; gustilo y anderson study found a considerable range of infection rates among the subtypes of Type III injuries, with 1.

gustilo y anderson


Limitations The Gustilo-Anderson classification is widely used [ 6 ], and is the basic language with which many investigators communicate the results of open fracture treatment [ 5 ]. However, the Gustilo-Anderson classification is limited because gustilo y anderson seeks to contain an almost limitless variety of injury patterns, mechanisms, and severities with a small number of discrete categories [ 32 ].

Another critical limitation is that the surface injury does not always reflect the amount of deeper tissue damage and the Gustilo y anderson classification does not account for tissue viability and tissue necrosis, which tend to evolve with time after more severe injuries.

Because open fractures may be underclassified on initial evaluation in the emergency department, many investigators agree that definitive classification that is, the classification that will drive the eventual treatment decisions of open fractures is best made in the operating room [ 3132223 ].

Gustilo open fracture classification - OrthopaedicsOne Articles - OrthopaedicsOne

Gustilo and Anderson [ 16 ] emphasized the importance of debridement but Pollak et al. Furthermore, Webb et al. Finally, Bowen and Widmaier found that the number of compromising comorbidities to be significant independent predictors gustilo y anderson infection [ 4 ].

Studies such as these challenge the true prognostic ability of the Gustilo-Anderson classification.

Gustilo open fracture classification - Wikipedia

Another limitation is the two studies [ 1617 ] were unbalanced in their numbers comparing the retrospective and prospective data without rigid statistical analysis; all long-bone open fractures were included despite different bones inherently having different risks of infection owing to their particular soft tissue envelope [ 16 ].

An area of controversy, gustilo y anderson least earlier on [ 1617 ], pertained to the treatment of fractures in this spectrum of injury.


Gustilo and Anderson originally recommended against early fracture fixation for many Type III injuries. Newer evidence shows that stabilization of many of these fractures—even with internal fixation—reduces the risk of infection and malunion, promotes fracture healing, restores function, and expedites rehabilitation [ 4 ].

Open segmental fracture, irrespective of the size of the wound Gunshot wounds -high velocity gustilo y anderson 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 gustilo y anderson 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.

  • Gustilo-Anderson Classification
  • A Suitable Option for Gustilo and Anderson Grade III Injury
  • Gustilo open fracture classification
  • A Suitable Option for Gustilo and Anderson Grade III Injury
  • Background

The fracture was then fixed with a combination of external fixators to maintain the gustilo y anderson length and fracture lines of force. In patients with Gustilo Gustilo y anderson C open tibial fractures, we repaired the damaged main blood vessels and nerves, including the anterior and posterior tibial vessels, tibial nerves, and peroneal nerves as far as possible.

Soft-tissue defects of the skin wound were covered with vacuum-closed drainage until they were treated again in the second stage.

The tendons and bones were not exposed in eight cases, in which thick free skin grafts were used to cover the wound. Free flap grafts were used to cover the wound in 12 cases: Transplantation of pedicled skin flaps was performed in five cases: In such cases, the external fixator was dismantled and replaced with the internal fixator, and the gustilo y anderson defect was treated with iliac bone grafts at the same time if necessary.

In the third stage plates were used in 9 cases; and intramedullary nail was used in 7 cases.

In 12 cases, the bone defects were fixed with bone grafts; the defects were 1 cm to 4 gustilo y anderson in size. The bone graft was taken from the iliac bone.

Internal fixation could not be done in 9 cases, in which bone transport was performed with an external fixator.