Gustilo-Anderson Classification
Classifies open fractures by wound size and contamination to guide antibiotic selection and surgical management.
Score interpretation
Gustilo Type I: Low-energy, clean wound < 1 cm. Infection risk ~0–2%.
→ Co-amoxiclav 1.2g IV (or cefuroxime 1.5g IV) within 3 hours of injury. Wound irrigation and debridement. Primary closure usually possible.
Gustilo Type II: Moderate energy, wound 1–10 cm, minimal contamination. Infection risk ~2–7%.
→ Co-amoxiclav 1.2g IV 8-hourly. Thorough debridement. Definitive fixation at same sitting if vascular/soft tissue allows. Ortho-plastics co-management.
Gustilo Type IIIA: High energy, large wound, but adequate bone coverage. Infection risk ~7%.
→ Co-amoxiclav + metronidazole IV. Formal debridement in theatre within 24h. Definitive closure / coverage aim within 72h. Ortho-plastics MDT.
Gustilo Type IIIB: Extensive soft tissue loss, periosteal stripping, bone exposure. Requires flap. Infection risk ~10–50%.
→ Broad-spectrum IV antibiotics. Orthoplastic team (combined ortho + plastics). External fixation initially. Soft tissue cover within 72h (free flap or local flap).
Gustilo Type IIIC: Arterial injury requiring vascular repair. Amputation risk ~25–90%.
→ EMERGENCY vascular surgery. Orthoplastic team. Temporary vascular shunting then bony stabilisation then vascular repair sequence. High amputation rate — discuss with patient.
Interpretation bands for the Gustilo-Anderson. Apply clinical judgement and local guidance.
References
- Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones. J Bone Joint Surg Am. 1976.
- BOAST 4: The Management of Severe Open Lower Limb Fractures. British Orthopaedic Association. 2009.
Related
Curated clinical cross-links plus same-class fallbacks.
- Co-amoxiclav (Open Fracture Antibiotic Prophylaxis) · Beta-lactam / Beta-lactamase Inhibitor Combination
- Piperacillin-Tazobactam (Polymicrobial Open Fracture Infections) · Extended-spectrum Beta-lactam / Beta-lactamase Inhibitor
- Zinc Oxide · Barrier / Astringent / Wound Dressing
- Chlorhexidine with cetrimide · Skin antiseptic / wound cleanser
- Birch bark extracts (betulin) · Topical wound healing agent
- Bevacizumab (Intravitreal) · Anti-VEGF (Vascular Endothelial Growth Factor Inhibitor)
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.