You are here

Open Fracture Classification

   Gustilo-Anderson Grade I
  • <1cm long
  • clean wound
  • minimal soft tissue injury
  • simple fracture with minimal comminution

Treatment

  • IV antibiotics. Cefazolin 2 grams IV Q8hrs for 3 days. (Wilkins J, Orthop Clin North Am 1991;22:433). Clindamycin 600mg IV Q8hrs in PCN allergic.
  • Tetnus vaccination should be given if last vaccination was > 10yrs prior or unknown.
  • Photograph the injury.
  • Operative debridement.
Gustilo-Anderson Grade II
  • >1cm long
  • moderate contamination
  • moderate soft tissue damage
  • moderate comminution

Treatment

  • IV antibiotics. Cefazolin 2 grams IV Q8hrs + Levaquin* 500mg IV QD for 3 days. (Wilkins J, Orthop Clin North Am 1991;22:433). *(risk of renal failure with aminoglycosides). Clindamycin 600mg IV Q8hrs + Levaquin if PCN allergic.
  • Tetnus vaccination should be given if last vaccination was > 10yrs prior or unknown or if >5yrs for severe contamination.
  • Photograph the injury.
  • Operative debridement.
Gustilo-Anderson Grade IIIA
  • >10cm long
  • highly contaminated
  • Severe soft tissue injury with cruching, but wound soft tissue coverage is possible
  • Usually comminuted

Treatment

  • IV antibiotics. Cefazolin 2 grams IV Q8hrs + Levaquin* 500mg IV QD for 3 days. Add penicillin for any wound heavily contaminated with soil.(Wilkins J, Orthop Clin North Am 1991;22:433). *(risk of renal failure with aminoglycosides). Clindamycin 600mg IV Q8hrs + Levaquin if PCN allergic.
  • Tetnus vaccination should be given if last vaccination was > 10yrs prior or unknown or if >5yrs for severe contamination.
  • Photograph the injury.
  • Operative debridement.
Gustilo-Anderson Grade IIIB
  • >10cm long
  • highly contaminated
  • Very severe soft tissue injury usually requiring reconstructive surgery for coverage
  • May be severely comminuted
  • IV antibiotics. Cefazolin 2 grams IV Q8hrs + Levaquin* 500mg IV QD for 3 days. Add penicillin for any wound heavily contaminated with soil.(Wilkins J, Orthop Clin North Am 1991;22:433). *(risk of renal failure with aminoglycosides). Clindamycin 600mg IV Q8hrs + Levaquin if PCN allergic.
  • Tetnus vaccination should be given if last vaccination was > 10yrs prior or unknown or if >5yrs for severe contamination.
  • Photograph the injury.
  • Operative debridement.
Gustilo-Anderson Grade IIIC
  • >10cm long
  • highly contaminated
  • Very severe soft tissue injury with vascular injury requiring repair; usually requires reconstructive surgery for coverage
  • May be severely comminuted
  • IV antibiotics. Cefazolin 2 grams IV Q8hrs + Levaquin* 500mg IV QD for 3 days. Add penicillin for any wound heavily contaminated with soil.(Wilkins J, Orthop Clin North Am 1991;22:433). *(risk of renal failure with aminoglycosides). Clindamycin 600mg IV Q8hrs + Levaquin if PCN allergic.
  • Tetnus vaccination should be given if last vaccination was > 10yrs prior or unknown or if >5yrs for severe contamination.
  • Photograph the injury.
  • Operative debridement.
   

Disclaimer

The information on this website is intended for orthopaedic surgeons.  It is not intended for the general public. The information on this website may not be complete or accurate.  The eORIF website is not an authoritative reference for orthopaedic surgery or medicine and does not represent the "standard of care".  While the information on this site is about health care issues and sports medicine, it is not medical advice. People seeking specific medical advice or assistance should contact a board certified physician.  See Site Terms / Full Disclaimer