12/5/2017 Gustilo Classification - Trauma - Orthobullets.

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Gustilo 12 2 0 31 3 0
Trauma Classification
Authors: Amiethab Aiyer | Ben
Taylor

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Type I
wound < 1 cm

Type II
1-10cm
GENERAL TRAUMA
Type III A
EVALUATION

> 10 cm, high energy
adequate tissue for coverage
High-Yield Topics
includes segmental / comminuted fractures even if wound <10cm
Evaluation, Resuscitation & farm injuries are automatically Gustillo III
DCO
Type IIIB
Gustilo Classification extensive periosteal stripping and requires free soft tissue transfer
Tscherne Classification
Type IIIC
vascular injury requiring vascular repair
Trauma Scoring Systems

Open FX Management Complete version

SPECIFIC
PRESENTATIONS

Gustilo Type I II IIIA IIIB IIIC
Images
COMPARTMENT
SYNDROME Energy Low energy Moderate High High High

INFECTION
Wound Size < 1 cm > 1cm >10cm >10cm >10cm

UPPER EXTREMITY Soft Tissue Minimal Moderate Extensive Extensive Extensive

SHOULDER Moderate
Contamination Clean Extensive Extensive Extensive
contamination
HUMERUS
Severe
Simple fx pattern Severe comminution
Fracture Moderate comminution or Severe comminution or
ELBOW with minimal or segmental
Pattern comminution segmental segmental fractures
comminution fractures
FOREARM fractures
Periosteal
No No Yes Yes Yes
PELVIS TRAUMA Stripping
Requires free
PELVIS

Local Local coverage tissue flap or Typically requires flap

Skin Coverage Local coverage
ACETABULUM coverage including rotational flap coverage
coverage
LOWER EXTREMITY Exposed fracture with
Neurovascular
Normal Normal Normal Normal arterial damage that
FEMUR Injury
requires repair
KNEE Antibiotics
1st generation 1st generation cephalosporin for gram
LEG cephalosporin for positive coverage.
24 hours after Aminoglycoside (such as gentamicin) for
ANKLE & HINDFOOT
closure gram negative coverage in type III
injuries

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the
cephalosporin/aminoglycoside
should be continued for 24-72
hours after the last
debridement procedure
Penicillin should be added if concern for
Trauma anaerobic organism (farm injury)

Flouroquinolones
should be used for fresh water wounds or salt water
Antibiotics
wounds
(other
can be used if allergic to cephalosporins or clindamycin
considerations)
Doxycycline and ceftazidime
can be used for salt water wounds

Antibiotic Indications for Open Fractures

Gustillo Grade I and II

1st generation cephalosporin
Gustillo Grade III
1st generation cephalosporin + aminoglycoside
traditionally recommended, but there is no evidence in the
literature to support its use
With farm injury / bowel contamination
1st generation cephalosporin + aminoglycoside + PCN
add PCN for clostridia
Duration
initiate as soon as possible
increased infection rate when antibiotics are delayed > 3 hours
from time of injury
continue for 72 hours after I&D
48 hours after each procedure
Tetanus booster if not up to date

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QUESTIONS (1)

QUESTIONS

1 of 1 Previous Next 0%

(OBQ12.156) A 36-year-old male sustains an open segmental tibia fracture associated with an
overlying 8 cm soft tissue avulsion that requires skin grafting for soft tissue coverage. No vascular
injury is identified. What is the most appropriate Gustilo-Anderson classification of this injury? Review
Topic
QID: 4516

1 Type I

2 Type II

3 Type IIIA

4 Type IIIB

5 Type IIIC

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Select Answer to see Preferred Response

CASES (2)

OPEN TIBIA AND FIBULA FRACTURE (C2 9/7/2016
Trauma
Trauma - Gustilo Classification 1378
HPI - MOTOR BIKE ACCIDENT 8
What would be your initial treatment of this patient? 10

Open injury of the dorsal surface of the fo 7/8/2016

Trauma - Gustilo Classification 1187
HPI - The patient reported an injury of the right f 16
In light of the fact that the tendon and joint are ex 6

GROUPS (1)

Oral Boards: Gustilo Classification 7/29/2011

General - Oral Boards Review 0

EVIDENCE & REFERENCES (12)

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80%
Cost Effectiveness (more )

60%

40%

20%

9.0
0%
0 1 2 3 4 5
Clinical Impact (increase )

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