Gustilo-Anderson Classification of Open Fracures


  • Follow ALTS approach - beware of other injuries
  • Analgesia
  • Higher classification = more contamination, higher neurovascular risk
  • Higher classification = ↑↑risk infection
  • Repeated secondary assessment (NV status)
  • Early antibiotics
  • Remove gross contamination but do not irrigate (needs theatre)
  • Betadine dressing and early immobilisation
Gustilo_Anderson 3b


Gustilo-Anderson classification

Characteristic Type 1 Type 2 Type 3a Type 3b Type 3c
Wound size <1 cm >1 cm <10 cm >10 cm Any size
Contamination Clean Moderate
Soft tissue injury Minimal Minimal Crushed tissue Extensive Extensive
Fracture pattern Simple Moderate comminution Segmental with displacement
Diaphyseal segment loss
Gunshot wound
Soft tissue coverage Adequate Adequate Adequate Inadequate—plastic surgery needed Possible amputation needed
Vascular injury None None None None Present

Content by Dr Íomhar O' Sullivan 19/09/2014. Last review Dr ÍOS 24/10/22.