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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?
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An 8cm open segmental tibia fracture requiring skin grafting (but not a skin flap) qualifies as a Gustilo Type IIIA.
An open segmental tibia fracture meets criteria to be a type III injury, and subclassification as a IIIA is due to the lack of a need for free or regional tissue transfer for coverage. Classification as a type IIIB would require a free or regional soft tissue transfer (flap) for coverage. Also, remember that definitive classification is done intraoperatively, after full assessment of the fracture and wound are complete.
Gustilo et al. performed a retrospective review of 673 patients and a prospective review of 352 patients with open fractures. Infection rate of the type I and II in the retrospective series was 12%, and this decreased with use of a standardized modern treatment protocol to 2.5% in the prospective cohort. Type III deep infection rate was 44% in the retrospective study and 9% in the prospective study.
Answer 1: Involves a wound <1 cm with minimal soft tissue stripping; simple fracture pattern
Answer 2: Involves a wound 1-10cm with mild soft tissue stripping; simple fracture pattern or mild comminution
Answer 4: Involves extensive soft tissue damage with high-energy fracture pattern; soft tissue requires free tissue transfer for coverage
Answer 5: Involves a vascular injury requiring repair
Gustilo RB, Anderson JT
J Bone Joint Surg Am. 1976 Jun;58(4):453-8. PMID: 773941 (Link to Abstract)
Gustilo, JBJS 1976
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