Review Question - QID 4795

A Gustilo-Anderson IIIB fracture is defined as a high-energy open fracture with extensive soft tissue damage and periosteal stripping that will require a free flap or rotational flap for coverage.

The Gustilo-Anderson classification is the most commonly used classification system for open fractures. In addition to looking at the size of the wound, it looks at the presence of neurovascular injury, degree of contamination, and degree of periosteal stripping. While it is extremely useful for communication and descriptive purposes, it also serves to guide treatment and predict prognosis (risk for infection).

Gustilo et al. retrospectively analyze 673 open fractures and prospectively analyze 352 patients treated for open fractures. 70.3% of the open wounds were culture positive, leading the authors to conclude that antibiotics were therapeutic, rather than prophylactic, in most cases. Additionally, they recommend delayed surgical fixation in the setting of extensive soft tissue damage.

Gustilo et al. analyze factors that contribute to the increased incidence of complications associated with Type III open fractures. The four factors identified were 1) massive soft tissue damage, 2) wound contamination, 3) compromised vascularity, and 4) fracture instability.

Illustration A shows the Gustilo-Anderson classification system.

Incorrect Answers:
Answer 1: This describes a Type IIIC fracture, as vascular repair will be required given the lack of distal circulation.
Answer 2: This describes a Type IIIA fracture, as it is amenable to primary closure.
Answer 3: The need for fasciotomies is not accounted for in the Gustilo-Anderson classification system, and there is no mention of flap coverage for this particular injury.
Answer 5: This is a closed injury, thus is not classified according to the Gustilo-Anderson system.