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Wheeless' Textbook of Orthopaedics

Gustilo Classification of Open Tibial Frxs



- See: Open Fractures of the Tibia:

- Discussion:
    - Gustillo classification describes soft tissue injury, but does not necessarily describe fracture comminution;

- Grade I:
        - wound less than 1 cm w/ minimal soft tissue injury;
        - wound bed is clean
        - bone injury is simple w/ minimal comminution;
        - w/ IM nailing, average time to union is 21-28 weeks; 
        - ref: Treatment of isolated type I open fractures: is emergent operative debridement necessary? 

- Grade II:
        - wound is greater than 1 cm w/ moderate soft tissue injury;
        - wound bed is moderatedly contaminated;
        - fracture contains moderate comminution;
        - w/ IM nailing, average time to union is 26-28 weeks;

- Grade III:
    - following frx automatically results in classification as type III:
         - segmental frx w/ displacement
         - frx w/ diaphyseal segmental loss;
         - frx w/ associated vascular injury requiring repair;
         - farmyard injuries or highly contaminated wounds;
               - in the report by Hill PF, et al, an ovine model was developed to study the outcome following IM nailing of a heavily contaminated fracture;
                      - those animals in the treatment group received wound debridement, lavage and the use of appropriate systemic antibiotics;
                      - despite this, infection developed at the osteotomy site and along the entire length of the implant in all animals;
                      - the authors conclude that that heavily contaminated fractures should not be treated by primary intramedullary nailing; 
         - high velocity GSW;
         - frx caused by crushing force from fast moving vehicle; 
                       - Early intramedullary nailing in an animal model of a heavily contaminated fracture of the tibia.
    - grade III A frx:
         - wound less than 10 cm w/ crushed tissue and contamination;
         - soft tissue coverage of bone is usually possible;
         - w/ IM nailing, average time to union is 30-35 weeks;
    - grade III B frx:
         - wound greater than 10 cm w/ crushed tissue and contamination;
         - soft tissue is inadequate and requires regional or free flap;
         - w/ IM nailing, average time to union is 30-35 weeks;
    - grade III C:
         - is frx in which there is a major vascular injury requiring repair for limb salvage;
         - fractures can be classified using the MESS:
         - in some cases it will be necessary to consider BKA following tibial frx


Gustilo-Anderson Classification

Classification of type III (severe) open fractures relative to treatment and results.

Interobserver agreement in the classification of open fractures of the tibia. The results of a survey of two hundred and forty-five orthopaedic surgeons [see comments].

Open fractures of the tibia in children.

Plates versus external fixation in severe open tibial shaft fractures. A randomized trial.

Severe open fractures of the tibia

Severe open tibial fractures: a study protocol.

Severe open tibial fractures. Results treating 202 injuries with external fixation.

Treatment of open tibial-shaft fractures. External fixation and secondary intramedullary nailing.

The timing of flap coverage, bone-grafting, and intramedullary nailing in patients who have a fracture of the tibial shaft with extensive soft-tissue injury.

Segmental tibial defects. Comparing conventional and Ilizarov methodologies.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Tuesday, May 29, 2012 11:42 am