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.

Xrays

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.

Xray