The Gustilo Anderson classification, also known as the Gustilo classification, is the most widely accepted classification system of open (or compound) fractures.

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The grading system is used to guide management of compound fractures, with higher grade injuries associated with higher risk of complications. Soft tissue injury is graded on a combination of:

• amount of energy dissipated
• extent of soft-tissue injury
• degree of contamination

NB: fracture comminution is not considered in the grading system.

Gustilo-Anderson classification

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• grade 1: clean wound <1 cm in length
• grade 2: wound 1-10 cm in length without extensive soft-tissue damage, flaps or avulsions
• grade 3: extensive soft-tissue laceration (>10 cm) or tissue loss/damage or an open segmental fracture
  • open fractures caused by farm injuries
  • injuries requiring vascular intervention
  • fractures that have been open for 8 hours prior to treatment

Grade 3 injuries can be further subdivided by the degree of periosteal and vascular injury and soft tissue loss:

• grade 3a: adequate periosteal coverage of the fracture bone despite the extensive soft-tissue laceration or damage
• grade 3b
  • extensive soft-tissue loss, periosteal stripping and bone damage
  • usually associated with massive contamination
  • will often need further soft-tissue coverage procedure (e.g. free or rotational flap)
• grade 3c: associated with an arterial injury requiring repair, irrespective of degree of soft-tissue injury

Treatment and prognosis

Surgical management:

• injuries up to and including grade 3a can be treated with local soft tissue coverage
• grade 3b injuries require free or rotational flap repair
• grade 3c injuries require vascular repair and usually soft tissue free or rotational flap repair

Antimicrobial treatment:

• all injuries require antibiotic coverage (usually a first-generation cephalosporin)
• grade 3 injuries are usually also covered with gentamycin (for Gram-negative coverage)
• farm injuries are usually also covered with penicillin (for anaerobe coverage)

• 1. http://www.orthobullets.com/trauma/1003/gustilo-classification
• 2. Zalavras CG, Marcus RE, Levin LS et-al. Management of open fractures and subsequent complications. J Bone Joint Surg Am. 2007;89 (4): 884-95. J Bone Joint Surg Am (abstract) - Pubmed citation

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