gustilo classification

Management

Tibial facture with break in skin

- open wound communicating with fracture or haematoma

Patient is immediately at higher risk of deep infection

Wound continuously oozes dark red fracture haematoma

Up to 1/4 of tibia fractures open

Grade 1

- wound < 1cm

- usually inside out

Knee > Hip

- superficial position

- limited cover of well vascularised muscle

- watershed area of skin blood supply anterior to the skin incision

- much increased in fully constrained prosthesis

Ideal < 1%

Increased with

- revision

- prior infection

- RA / Psoriatic arthropathy

- DM