Review Question - QID 1361

Figures A and B show a significantly comminuted, segmental tibial fracture. In this scenario, the fracture is appropriately classified as a Grade III because there is a highly comminuted, segmental fracture which is always associated with significant periosteal stripping. The patient's leg was able to be closed primarily, which means that it should be classified as a IIIA.

Gustilo et al reviews 18 years of open fracture treatment and outcomes. They reported that débridement and copious irrigation, with primary closure for type I and II fractures and secondary closure for type III fractures resulted in a 5% infection rate (9% for type III fractures). Initial wound cultures were positive in 70.3% despite an infection rate of that patient group of only 2.5%.

Incorrect Answers:
Answer 1: Gustilo Type I wounds have a clean skin lesion that are < 1 cm, and a simple fracture with minimal comminution.
Answer 2: Gustilo Type II wounds have a skin lesion > 1 cm, no extensive soft tissue damage, minimal crushing, and moderate comminution and contamination.
Answer 4: Gustilo Type IIIB are defined as wounds that require a flap for salvage.
Answer 5: Gustilo Type IIIC have an exposed fracture with arterial damage that requires repair.