Gustilo

Gustilo typically refers to the Gustilo-Anderson classification, a widely used system in orthopedic trauma for grading open fractures. Introduced in 1976 by Gustilo and Anderson, the classification assesses injury severity based on wound characteristics, soft tissue damage, contamination, and fracture pattern. It is used to guide initial management and to estimate infection risk and healing potential.

The classification divides open fractures into three main types, with type III further subdivided. Type I describes a clean wound less than 1 cm with a relatively simple fracture. Type II covers wounds greater than 1 cm without extensive soft tissue damage, flaps, or avulsions. Type III represents high-energy injuries with extensive soft tissue damage, contamination, or crushing and is subdivided into IIIA, IIIB, and IIIC. IIIA denotes adequate soft tissue coverage despite extensive injury; IIIB involves extensive soft tissue loss with bone exposure and periosteal stripping, typically requiring soft tissue reconstruction; IIIC includes any open fracture with arterial injury that requires repair, regardless of soft tissue condition.

Clinical use and limitations: The Gustilo-Anderson classification informs decisions about debridement timing, antibiotic therapy, and fixation strategies (such as external versus internal fixation) and provides prognostic information regarding infection and healing. However, it has limitations, including interobserver variability and evolving understanding of soft tissue injury, contamination, and patient factors. Some practitioners advocate complementary scoring systems or revisions to reflect modern trauma care.

Origin and influence: The system originated from the work of Gustilo and Anderson and has become a standard framework in orthopedic trauma education, research, and clinical practice, though newer refinements and alternatives exist in contemporary guidelines.