A 32-year-old male presents to the emergency department 2 hours after a motorcycle accident with a compound fracture of the right tibia. The wound is 3 cm long with minimal contamination, and the fracture is simple. On examination, there is no vascular compromise or nerve injury. Which investigation is most appropriate to confirm the Gustilo classification and assess fracture geometry before surgical planning?

Explanation

## Investigation of Choice for Gustilo Classification Assessment **Key Point:** Plain radiographs (AP and lateral views) are the investigation of choice for initial assessment of open fractures and confirmation of Gustilo classification. They provide rapid, cost-effective imaging to determine fracture type, comminution, and bone loss. ### Why Plain Radiographs Are First-Line 1. **Rapid availability** — essential in trauma settings where time-sensitive decisions are made 2. **Fracture geometry visualization** — clearly shows fracture pattern (simple vs. comminuted), which is a key component of Gustilo grading 3. **Establishes baseline** — documents initial displacement and alignment before surgical intervention 4. **Guides surgical approach** — helps determine fixation strategy (external fixation vs. ORIF) ### Gustilo Classification Components | Grade | Wound Size | Contamination | Soft Tissue Injury | Fracture Type | |-------|-----------|----------------|-------------------|---------------| | I | <1 cm | Minimal | Minimal | Simple | | II | 1–10 cm | Moderate | Moderate | Simple/comminuted | | III | >10 cm | Severe | Severe | Comminuted | | IIIA | — | — | Adequate soft tissue coverage | — | | IIIB | — | — | Inadequate soft tissue coverage | — | | IIIC | — | — | Vascular injury requiring repair | — | **High-Yield:** Plain radiographs are sufficient to determine fracture comminution (simple vs. comminuted), which directly influences Gustilo grade assignment. Advanced imaging is reserved for surgical planning after classification is complete. ### Clinical Pearl In this case, the fracture is described as **simple** with a **small wound (<3 cm)** and **minimal contamination** — these features point to **Gustilo Grade I or II**. Plain radiographs will confirm the fracture geometry and guide the decision between primary closure with antibiotics or surgical debridement. **Tip:** Always obtain radiographs before any advanced imaging in open fractures. The Gustilo grade drives antibiotic duration and surgical timing, and plain films provide this information immediately.