Tuesday, August 2, 2016

Open fracture and gustillo classification

Fracture: Fracture may be defined as a breach in the natural structure of a bone or a cartilage. Fracture is grossly classified into two major catagories, named open fracture and closed fracture. 
An Open Fracture 

Classification of Open Fracture 

Open fracture is one where the fracture fragments come in contact with the external environment. And close fracture is one where the fracture fragments do not come in contact with the external environment. A close fracture is better than an open fracture. An open fracture is dangerous because the chance off infection is more here. And this infection can result in ostiomyelitis or delayed unnion or malunion or non union.
All the open fractures are not equally dangerous. To know, how much dangerous an open fracture is, you have to know the gustillo open fracture classification properly. 
Gustillo open fracture classification is made on the basis of wound size, degree of communication, vascular injury, soft tissue injury and neuro vascular status. 
Type-I Open fracture: This is an open fracture where the wound size is less than 1cm. loss of blood is not so much. No crashing injury is present. 
Type-II Open fracture: This type of open fracture is worse than Type-I. Here the wound size is more than 1cm but less than 10cm. Soft tissue injury and bleeding is moderate.
Type-III Open fracture : Here the wound size is more than 10cm. Communication of the fracture fragment with the environment is more than the previous fracture. This Type-III fracture has some sub division.
Type-IIIa: Here adequate soft tissue is present to cover the fracture fragments. 
Type-IIIb: Here adequate soft tissue is not present to cover the fracture fragments. 
Type-IIIc: Here the vascular supply is compromised.  
Nevertheless the above discussion, one must keep in mind that any open fracture with vascular injury will treated as a Type-III open fracture. 

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