Gustilo open fracture classification

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The Gustilo open fracture classification system is the most commonly used classification system for open fractures. This was made by Ramón Gustilo and Anderson, and then expanded by Gustilo, Mendoza, and Williams.

This system uses the amount of energy, the level of soft tissue damage and the level of contamination for fracture severity. Advances from grade 1 to 3C imply higher levels of energy involved in injury, higher soft tissue and bone damage and higher potential complications. It is important to recognize that grade 3C fracture implies vascular injury as well.

Video Gustilo open fracture classification

Classification

Maps Gustilo open fracture classification

Reliability

There is much discussion about the reliability of this class-system observer. Different studies show an inter-observer reliability of about 60% (ranging from 42 to 92%), representing a poor to moderate agreement, which is the limitation of this classification system. This is due to many overlapping criteria with possible observer error. However, this classification is easy to use, able to predict prognostic outcomes and guide care. Generally, the higher the level of classification of Gustillo, the higher the rate of infection and complications. But treatment regimens should be interpreted with caution because of observer error.

Although this classification system has a good enough ability to predict outcomes, it is not perfect. The Gustillo classification does not take into account viability and soft tissue death over time which may affect the outcome of the injury. In addition, the number of underlying medical illnesses also affects the outcome. Whether wound debridement time, soft tissue coverage, and bone have benefits on results is also questionable. In addition, different types of bones have different rates of infection as they are covered by various soft tissues. Gustilo initially did not recommend early wound closure and early fixation for Grade III fractures. But more recent studies have shown that early wound closure and early fixation reduce infection rates, encouraging fracture healing and early function recovery. Therefore, assessment of all open fractures should include mechanisms of injury, soft tissue appearance, possible levels of bacterial contamination and specific characteristics of the fracture. Accurate assessment of fractures can only be done in the operating room.

In 1976, Gustilo and Anderson completed the initial classification system proposed by Veliskasis in 1959. An initial study conducted by Gustilo in 1976, has demonstrated primary closure with Type I antibiotic prophylaxis and type II fractures reduced the risk of infection by 84.4 %. Meanwhile, the initial internal fixation and primary closure of the wound on Type III fractures have a greater risk of osteomyelitis. However, Type III fractures occur in 60% if all cases of fractures are open. Type III fracture infections are observed in 10% to 50% of the time. Therefore, in 1984, Gustilo subclassified Type III fractures into A, B, and C with the aim of guiding open fracture treatment, communication and research, and to predict outcomes. Based on previous research results, Gustilo initially recommended irrigation and surgical debridement therapy for all fractures with primary closure for type I and II fractures; secondary closure without internal fixation for Type III fracture. However, shortly thereafter, he recommended an internal fixation device for Type III fracture.

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References

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See also

• Tscherne Classification
• Hanover fracture scale
• AO soft network assessment system

Source of the article : Wikipedia