Unbounded Medicine

Open fractures are surgical emergencies because of its complications (soft tissue damage, infection, hemorrhage).

We at emergency department need a classification system that it is intented to determine the degree of that damage.

We have to make a rapid (also a good) interrogation of lession mechanisms (what, when,  where, who, associated lessions). REMEMBER: If a low-grade open fracture has 6hrs from the begining, it’s considered infected.

On 1984, Gustilo and Anderson made a classification system, wich is the following:

Type I open fracture. Wound less than 1 cm, without contamination and minimal injury of soft tissue.

Type II open fracture. Wound between 1 and 10 cm, mild contamination, extensive soft tissue damage and minimal to moderate crushing component.

Type III-A open fracture. Wound larger than 10 cm, severe contamination and severe crushing component.

Type III-B open fracture. Wound larger than 10 cm, severe contamination and severe loss of tissues.

Type III-C open fracture. Wound larger than 10 cm, severe contamination and neurovascular injury.

REFERENCES:
Gustilo, R.; Mendoza, R.; Williams, D. Problemsin the management of type III (severe) open fractures: A new classification of typeIII open fractures. J Trauma 24:742, 1984.

Regards,
Jon Mikel Iñarritu, M.D.

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