Lesson 4 of 13
In Progress


Jimmy November 20, 2021

Gustilo-Anderson Classification System

  • This is a grading system for the identification of open fractures and its severity.
  • Fractures are designated as one of these three types and subtypes based on:

Gustilo-Anderson Classification System
Type I FractureOpen fracture with clean wound <1cm long
Type II FractureOpen fracture with laceration >1cm long without extensive soft tissue damage
Type III FractureOpen segmental fracture, open fracture with extensive soft tissue damage, or traumatic amputation
Type IIIA FractureAdequate soft tissue coverage of a fractured bone despite extensive soft tissue laceration or flaps, or high energy trauma irrespective of the size of the wound
Type IIIB FractureExtensive soft tissue injury loss with periosteal stripping and bone exposure, usually associated with massive contamination
Type IIIC FractureOpen fracture associated with arterial injury repair

The difference of open fractures

Reliability of the classification and a collective understanding and agreement of observers remains an issue. With Gustilo-Anderson Classification, here are its limitations:

1.Does not take tissue viability or tissue necrosis into account.

2.Moderate to poor inter-observer reliability.

3.Wound size and outward appearance may not accurately identify the true extent of the injury.

  • a.Under-classifications has occurred on several accounts in the Emergency Department admission.
  • b.Classification can only be made most precisely by surgeon in the OR following wound exploration and debridement.