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Open Fracture Classification

 Open tibial shaft fracture image  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.
Grade 2 open distal radius fracture image 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.
Grade 3A open tibial shaft fracture image 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.
Grade 3B open fracture image 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.
Grade 3C open tibial shaft fracture image 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.