Appendix A: Gustilo Classification of Open Fractures

Gustilo Classification of Open Fractures

I Low-energy clean wound <1 cm with minimal soft tissue injury and comminution

II Wound >1 cm with moderate soft tissue damage and comminution. Soft tissue component often defined as disruption <10 cm without periosteal stripping. High-energy wound with skin wound <10 cm involving extensive software tissue destruction, segmental fracture with displacement or bone loss, high degree of contamination, and vascular injury.

IIIa Fracture wound >10 cm with crushed tissue and contamination but usually with adequate soft tissue coverage or any size open wound associated with a segmental fracture (2 or more major fracture lines with intercalary fragment(s)).

IIIb Fracture wound >10 cm with crushed tissue and contamination having inadequate soft tissue cover associated with periosteal stripping and often requiring transfer of rotational or vascularized tissue for soft tissue coverage.

IIIc Open fracture associated with a major vascular injury that requires repair for limb salvage.