This landmark 1976 paper analyzed 1,025 open long-bone fractures at a single institution across two eras. It introduced the Gustilo-Anderson three-type wound classification and tested a standardized treatment protocol to determine its effect on infection rates. The study compares a retrospective cohort (1955–1968) with a prospective protocol-driven cohort (1969–1973).
When a patient arrives with an open femur or tibia fracture, the first question is: what type is this wound? The Gustilo-Anderson classification — built from the data in this paper. Answers that question and drives your next decisions on closure timing, fixation strategy, and antibiotic choice.
For Type I and II fractures, primary closure is appropriate after thorough débridement and irrigation. For Type III fractures, primary closure is contraindicated: the 44% infection rate in this series is what happens when you close these wounds early.
Do not plan primary internal fixation for a contaminated open fracture without a vascular injury driving the decision. The protocol here withheld internal fixation entirely except in that scenario, and it achieved a 2.5% overall infection rate.
The >70% wound contamination rate is why every open fracture gets prophylactic antibiotics regardless of wound appearance. Cephalosporins remain first-line. The 1984 subdivision of Type III into IIIA, IIIB, and IIIC refined the classification further, but the core principles of this paper have not changed in 50 years.
This landmark 1976 paper analyzed 1,025 open long-bone fractures at a single institution across two eras. It introduced the Gustilo-Anderson three-type wound classification and tested a standardized treatment protocol to determine its effect on infection rates. The study compares a retrospective cohort (1955–1968) with a prospective protocol-driven cohort (1969–1973).
When a patient arrives with an open femur or tibia fracture, the first question is: what type is this wound? The Gustilo-Anderson classification — built from the data in this paper. Answers that question and drives your next decisions on closure timing, fixation strategy, and antibiotic choice.
For Type I and II fractures, primary closure is appropriate after thorough débridement and irrigation. For Type III fractures, primary closure is contraindicated: the 44% infection rate in this series is what happens when you close these wounds early.
Do not plan primary internal fixation for a contaminated open fracture without a vascular injury driving the decision. The protocol here withheld internal fixation entirely except in that scenario, and it achieved a 2.5% overall infection rate.
The >70% wound contamination rate is why every open fracture gets prophylactic antibiotics regardless of wound appearance. Cephalosporins remain first-line. The 1984 subdivision of Type III into IIIA, IIIB, and IIIC refined the classification further, but the core principles of this paper have not changed in 50 years.