IN BRIEF Gustilo-Anderson Classification

Open fractures usually are high-energy injuries. This, along with the exposure of bone and deep tissue to the environment, leads to increased risk of infection, wound complications, and nonunion [12, 28, 31]. Antibiotics, surgical débridement, and internal fixation have improved outcomes of open fracture management in important ways, but the underlying principles for treating open fractures have remained the same since World War I: primary asepsis, adequate debridement, immobilization, and protection of wounds against disturbance and reinfection [25, 26]. Despite the overall improvement in outcome after open fractures, the variable outcomes among different patterns of open fractures with differing severities prompted the development of grading systems that classify them based on increasing severity of the associated soft tissue injuries. These grading systems seek to help guide treatment, improve communication and research, and predict outcome. Such classifications have been in use for some time [29]; however, it is the Gustilo-Anderson classification that has become the most commonly used system for classifying open fractures. Early attempts by Veliskakis [29] at grading open fractures were refined by Gustilo and Anderson in 1976 [16]. After reviewing their initial classification of the most severe open injuries, Gustilo et al. subsequently modified their classification system into its current form in 1984 [17]. Ultimately, through their studies of prevention of infection in open long bone fractures [16, 17], Gustilo et al. outlined the general principles of management of open fractures, and helped define the contemporary approach to the treatment of open fractures.