Gustilo Classification

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Topic updated on 12/19/12 11:43pm
Abridged version
  • Type I: < 1 cm
  • Type II: 1-10cm
  • Type III: > 10 cm or high energy
    • A - adequate tissue for coverage
    • B - extensive periosteal stripping and requires flap
    • C - vascular injury requiring vascular repair
Complete version

Type 1
  • skin lesion < 1 cm
  • clean
  • simple bone fracture with minimal comminution
x
Type 2
  • skin lesion > 1 cm
  • no extensive soft tissue damage
  • minimal crushing
  • moderate comminution and contamination
x
 
Type 3
  • Extensive skin damage with muscle and neurovascular involvement AND/OR
  • High-speed crush injury
  • Segmental of highly comminuted fracture
  • Segmental diaphyseal loss
  • Wound from high velocity weapon
  • Extensive contamination of the wound bed
  • Any size open injury with farm contamination
x
A
  • Extensive laceration of soft tissues with bone fragments covered
  • usually high-speed traumas with severe comminution or segmental fractures
x
B
  • Extensive lesion of soft tissues with periosteal stripping and contamination
  • severe comminution due to high-speed traumas
  • usually requires replacement of exposed bone with a local or free flap as a cover
C
  • Exposed fracture with arterial damage that requires repair
x

Antibiotics


Type 1 & Type 2 • 1st cephalosporin (ancef) for gram positive coverag
Type 3 A, B, C • Aminoglycoside (such as gentamicin) for gram negative coverage
• 1st cephalosporin (ancef) for gram positive coverage
• penicillin should be added if concern for anaerobic organism (farm injury)


 

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