ED Coding and Reimbursement Alert

The Gustilo open fracture classification groups open fractures into three main categories designated as Type I, Type II, and Type III. Type III injuries, is further divided into Type IIIA, Type IIIB, and Type IIIC. The categories are defined by three characteristics, which include:

• Mechanism of injury
• Extent of soft tissue damage
• Degree of bone injury or involvement

The specific characteristics for each type are as follows:

Type I

• Wound < 1 cm
• Minimal soft tissue damage
• Wound bed is clean
• Typically low-energy type injury
• Fracture type is typically one of the following: 

Simple transverse

•        Short oblique
•        Minimally comminuted

Type II

• Wound > 1 cm
• Moderate soft tissue damage
• Minimal or no wound bed contamination
• Typically low-energy type injury
• Fracture type is typically one of the following: 

1. Simple transverse
2. Short oblique
3. Minimally comminuted

Type III

• Wound > 10 cm
• Extensive soft tissue damage
• Typically a high-energy type injury
• Highly unstable fractures often with multiple bone fragments
• Injury patterns resulting in fractures that are typically classified to this category include: 

1. Open segmental fracture regardless of wound size
2. Gun-shot wounds with bone involvement
3. Open fractures with any type of neurovascular involvement
4. Severely contaminated open fractures
5. Traumatic amputations
6. Open fractures with delayed treatment (over 8 hours)

Type IIIA

• Adequate periosteal coverage of the fracture bone despite the extensive soft-tissue laceration 
• No local or distant flap coverage required
• Fracture may be open segmental or severely comminuted and still be classified as Type IIIA

Type IIIB

• Extensive soft tissue loss
• Local or distant flap coverage required
• Wound bed contamination requiring serial irrigation and debridement to clean the open fracture site

Type IIIC

• Major arterial injury
• Extensive repair usually requiring the skills of a vascular surgeon is required for limb salvage.