Gustillo Classification of Open Tibial Frxs

- Grade I:
        - wound less than 1 cm w/ minimal soft tissue injury;
        - wound bed is clean
        - bone injury is simple w/ minimal comminution;
        - w/ IM nailing, average time to union is 21-28 weeks;

- Grade II:
        - wound is greater than 1 cm w/ moderate soft tissue injury;
        - wound bed is moderatedly contaminated;
        - fracture contains moderate comminution;
        - w/ IM nailing, average time to union is 26-28 weeks;

- Grade III:
    - following frx automatically results in classification as type III:
          - segmental frx w/ displacement
          - frx w/ diaphyseal segmental loss;
          - frx w/ associated vascular injury requiring repair;
          - farmyard injuries or highly contaminated wounds;
                - in the report by PF Hill et al, the authors An ovine model was developed to study the outcome following
                      intramedullary nailing of a heavily contaminated fracture;
                      - those animals in the treatment group received wound debridement, lavage and the use of appropriate systemic antibiotics;
                      - despite this, infection developed at the osteotomy site and along the entire length of the implant in all animals;
                      - the authors conclude that that heavily contaminated fractures should not be treated by primary intramedullary nailing;
          - high velocity GSW;
          - frx caused by crushing force from fast moving vehicle;
    - grade III A frx:
          - wound greater than 10 cm w/ crushed tissue and contamination;
          - soft tissue coverage of bone is usually possible;
          - w/ IM nailing, average time to union is 30-35 weeks;
    - grade III B frx:
          - wound greater than 10 cm w/ crushed tissue and contamination;
          - soft tissue is inadequate and requires regional or free flap;
          - w/ IM nailing, average time to union is 30-35 weeks;
    - grade III C:
          - is frx in which there is a major vascular injury requiring repair for limb salvage;
          - fractures can be classified using the MESS:
          - in some cases it will be necessary to consider BKA following tibial frx;