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.