## Gustilo Classification of Open Fractures The Gustilo and Anderson classification system stratifies open fractures by wound size, soft tissue damage, contamination, and vascular injury — each factor predicts infection risk and functional outcome. ### Type I vs Type II: Key Discriminator **Key Point:** Wound size and soft tissue injury extent are the PRIMARY discriminators between Type I and Type II open fractures. | Feature | Type I | Type II | Type III | |---------|--------|---------|----------| | **Wound size** | <1 cm | 1–10 cm | >10 cm OR extensive | | **Soft tissue damage** | Minimal | Moderate | Severe, devascularized | | **Contamination** | Minimal | Moderate | High (farm, marine, etc.) | | **Vascular injury** | Absent | Absent | May be present | | **Infection risk** | 0–6% | 2–16% | 25–50% | **High-Yield:** Type I fractures have a small, clean wound with minimal soft tissue stripping. Type II fractures have larger wounds (1–10 cm) with moderate soft tissue damage but no major vascular or nerve injury. ### Why Type I ≠ Type II Type I is essentially a "clean" open fracture — the bone has broken through the skin, but the wound tract is small and the surrounding soft tissues are largely intact. Type II involves more extensive soft tissue trauma, a larger wound, and greater contamination risk — but still lacks the severe devascularization or vascular injury seen in Type III. **Clinical Pearl:** A Type I fracture may be managed with primary closure after thorough debridement; Type II often requires serial debridement and delayed closure. **Mnemonic:** **WRIST** for Type I: **W**ound <1 cm, **R**ough (minimal) soft tissue damage, **I**nfection risk low, **S**mall laceration, **T**idy injury. [cite:Rockwood & Green's Fractures in Adults 9e Ch 12] 
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