Gustilo-Anderson open fracture grading

Type	Wound size	Contamination	Fracture	Vascular injury requiring repair	Soft tissue coverage
I	Wound <1 cm	Minimal	Minimal comminution; no periosteal stripping	No	Adequate
II	Wound >1 cm	Moderate	Moderate comminution; minimal periosteal stripping	No	Adequate
IIIA	Any size	Severe	Severe comminution or segmental fractures; periosteal stripping	No	Adequate; may become inadequate with debridements
IIIB	Any size	Severe	Severe comminution or segmental fractures; periosteal stripping	No	Inadequate (rotation flap or free flap)
IIIC	Any size	Severe	Severe comminution or segmental fractures; periosteal stripping	Yes	Inadequate (rotation flap or free flap)

References:

Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am 1976; 58:453.
Gustilo RB, Gruninger RP, Davis T. Classification of type III (severe) open fractures relative to treatment and results. Orthopedics 1987; 10:1781.

Graphic 110486 Version 2.0