The Gustilo open fracture classification system is the most commonly used classification system for open fractures. It was created by Ramón Gustilo and Anderson, and then further expanded. Open Fracture: Gustilo classification. Open fractures have been classified by Gustilo as follows, with higher numbers indicating more severe injuries. Open fractures, also called compound fractures, are severe injuries to bones. These injuries almost always require surgery. Learn more.
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Therefore, inGustilo subclassified Type III fractures into Classificafion, B, and C with the aim of guiding the treatment of open fractures, communication and research, and to predict outcomes. See Clin Orthop Relat Res. Each aspect of an open tibial fracture must be considered in planning initial and definitive management.
Primary internal fixation in open fractures of the tibial shaft: Views Read Edit View history. The Gustilo Anderson classificationalso known as the Gustilo classificationis the most widely accepted classification system of open or compound fractures.
Although the principles of management for open tibial fractures are constant, the path gusttilo the final result may vary. Although the Anderrson classification is useful, its interobserver reliability is limited [ 519 ] and it lacks the ability to comprehensively measure prognostic patient outcome [ 2830 ]; therefore, assessment of all open fractures should include the mechanism of injury, the appearance of the soft tissue envelope and its condition in the operating room [ 3132223 ], the level of likely bacterial contamination, and the specific characteristics of the fracture [ 133132 ].
A coefficient of agreement for nominal scales. This page was last edited on 27 Octoberat AO principles of fracture management, Volume 1. An additional influence is the ability of the host to combat infection, based on both systemic and local factors. Meanwhile, early internal fixation and primary closure of the wound in Type III fractures have a greater risk of getting osteomyelitis.
Trends in the management of open fractures: A full understanding of the severity of an open fracture requires consideration of each of these elements.
The medical information on this site is provided as an information resource only, and is classifiction to be used or relied on for any diagnostic or treatment purposes. L6 – years in practice.
Gustilo Anderson classification | Radiology Reference Article |
This is due to much of the criteria being at risk of observer errors, and is a known liability of this scaling system. J Am Acad Orthop Surg. This classificationn result directly from the injury or from delayed wound necrosis. Perhaps because of their more severe soft-tissue injury, open fractures may have a higher incidence of compartment syndrome than that of comparable closed injuries. Type III fractures, however, are not a homogeneous group; another guatilo found a considerable range of infection rates among the subtypes of Type III injuries, with 1.
Like many classification systems, the purpose of the Gustilo-Anderson schema is to provide a prognostic framework that guides treatment and facilitates communication among surgeons and clinician-scientists. Open tibial fractures can present as isolated injuries or in the context of a multiply injured patient. However newer studies have shown that early wound closure and early fixation reduces infection rates, promotes fracture healing and early restoration of function.
Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: The surgeon must anticipate this possibility, monitoring the patient carefully and considering fasciotomy during open fracture debridement.
Management of open fractures and subsequent complications. Open fractures of amderson tibia are the commonest of open long-bone fractures, perhaps because of its thin anteromedial soft-tissue coverage. A simple summary in how this can help to guide management is: Simple fx pattern with minimal comminution. Gustilo and Anderson then prospectively followed more than patients. Whilst most of these injuries can be safely managed on next day emergency lists, there are instances where emergency out-of-hours treatment is required.
Ultimately, through their studies of prevention of infection in open long bone fractures [ 1617 ], Gustilo et al.
Bone fractures Orthopedic classifications. Usually associated with massive contamination. 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 ].
Synonyms or Alternate Spellings: Gustilo initially does not recommend early wound closure and early fixation for Grade III fractures. Log in Sign up. The original study [ 16 ] included an initial retrospective evaluation, followed by a prospective test of the system that Gustilo and Anderson developed. An area of controversy, at least earlier on [ 1617 ], pertained to the treatment of fractures in this spectrum of injury. The variability among individuals and their interpretation of the Gustilo-Anderson classification [ 16 ] results in a spectrum of injuries having too much overlap [ 5 ], cllassification owing to the observer error [ 19 ].
Open Fractures – Classification – Management – TeachMeSurgery
KimMD and Seth S. If there is vascular compromisethis needs immediate surgical exploration by vascular surgery. Articles Cases Courses Quiz. What is the most appropriate Gustilo-Anderson classification of this injury? The Anderxon classification system remains the preferred system for categorizing open fractures.
Brumback and Jones [ 5 ] and Horn and Rettig [ 19 ] have examined the reliability of the Gustilo-Anderson classification system [ 1617 ].