Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses.
Gustilo RB, Anderson JT. The Journal of bone and joint surgery. American volume 1976 · PMID 773941 · doi:10.2106/00004623-200204000-00029
- Question
- What factors affect infection after open long bone fractures, and how should these injuries be classified and treated?
- Design
- Combined retrospective and prospective case series from a single US centre.
- Patients
- Over one thousand open fractures of long bones.
- Intervention
- Debridement, irrigation, antibiotics and primary closure or delayed closure depending on wound type
- Comparison
- Different wound types and treatment approaches
- Primary outcome
- Infection rate
- Key result
- Introduced the Gustilo-Anderson classification (types I to III) and showed infection risk rose with severity of soft tissue injury, supporting prophylactic antibiotics and leaving severe wounds open.
- Limitations
- Observational single-centre data, and the classification has only moderate interobserver reliability and should be assigned after debridement.
- Impact on practice
- The classification remains the standard language for describing open fractures in the UK, and the paper established antibiotics as part of open fracture care.