Gustilo Anderson Classification of Open Fractures

Gustilo Anderson classification is the most commonly used system to classify open fractures

It was created by American orthopedic surgeons Ramon Gustilo, John Anderson and Thomas Williams in 1984

Classifies open fractures based on size of the wound, soft tissue damage and degree of contamination

Helps guiding treatment decisions and prognosis , also help in deciding the antibiotic cover used

The higher the grade of the injury , the higher the risk of infection and thus the more aggressive antibiotic regimen

Classification

Grade	Description
Grade 1	Wound length: Small wound less than 1 cm in length, punctured by a bone spike The fracture caused by low energy injury mechanism There is little soft tissue damage Clean wound
Grade 2	Wound length: Larger wound, more than 1 cm in length but less than 10 cm Low to moderate energy injury mechanism There is more soft tissue damage than type 1 but still minimal Moderate contamination of the wound
Grade 3	Wound length: even larger wound, more than 10 cm in length High energy injury mechanism Large laceration, extensive damage to skin and underlying soft tissue and maybe vascular compromise Contamination is extensive Furtherly classified into 3 types: Grade 3 A: No extensive soft tissue loss or periosteal stripping => the fractured bone can be adequately covered by the available soft tissue Grade 3 B: Extensive periosteal stripping and tissue loss. The fracture cover not possible without the use of flaps Grade 3 C: Arterial injury that need to be repaired regardless of the amount of soft tissue damage. So any open fracture with any length if associated with arterial injury then considered type 3 C

Choice of antibiotic vary depending on local protocol
typically consist of either a cephalosporin antibiotic (e.g. cefuroxime 1.5g 3 times daily) or a penicillin antibiotic (e.g. co amoxiclav 1.2 g 3 times daily) but If patient has penicillin allergy then clindamycin (600mg four times daily)
This antibiotic is used as soon as possible when patient get to the hospital and continue to be used for 1 day after wound debridement if the injury was grade 1 and for 3 days after wound debridement if the injury was grade 2 and 3
At wound debridement add aminoglycoside antibiotic for all the grades (e.g. gentamicin 1.5 mg/kg three times daily)
If wound cover is not possible at debridement and to be delayed until grafting or the fracture is grade 3 b or c then add vancomycin or teicoplanin
Anti tetanus toxoid given with higher grades and depending on local protocol