A 32-year-old male presents to the emergency department following a motorcycle accident with a compound fracture of the tibia. The wound measures 1 cm, there is minimal soft tissue damage, no vascular compromise, and no gross contamination. Which single feature best distinguishes this injury as Gustilo Type I rather than Type II?

Question

Accepted Answer

A. Wound size less than 1 cm with minimal soft tissue injury. ## 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]

![Open Fracture — Gustilo Classification diagram](https://mmcphlazjonnzmdysowq.supabase.co/storage/v1/object/public/blog-images/explanation/4144.webp)

Answer

B. Extensive muscle damage and devascularization

Answer

C. High-velocity mechanism with severe contamination

Answer

D. Presence of vascular injury requiring repair

Explanation

Gustilo Classification of Open Fractures

Type I vs Type II: Key Discriminator

Why Type I ≠ Type II

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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%