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Review Paper | Orthopaedic Surgery | Volume 15 Issue 7, July 2026 | Pages: 883 - 891 | India
The Modified Gustilo-Ganga Multidomain Open Fracture Classification and Severity Score: A Literature-Based Proposal for Unified Descriptive and Prognostic Documentation of Open Extremity Fractures
Abstract: Background: The Gustilo-Anderson classification is the most widely used system for classifying open fractures, but it has limitations. Its interpretation can vary, and it does not fully assess tissue injury, contamination, vascular problems, bone loss, patient risk, or timing of treatment. The Ganga Hospital Open Injury Severity Score (GHOISS) is a validated tool for predicting outcomes in severe open tibial injuries, but it is not a general descriptive system. Today, orthoplastic care needs clear documentation of vascular status, contamination, timing, and readiness for reconstruction. Objective: To suggest a new open fracture classification system, based on the literature, that keeps the simplicity of Gustilo-Anderson, uses the prognostic strengths of GHOISS, and adds modern modifiers for complete documentation of extremity injuries. Methods: We reviewed key literature on Gustilo-Anderson, GHOISS, OTA/AO open fracture classification, mangled extremity scores, infection and nonunion risk, vascular injury, timing of antibiotics and debridement, and orthoplastic reconstruction. Based on this, we propose a new classification system and outline a plan for future validation. Proposal: The Gustilo-Ganga Open Fracture Classification and Severity Score (GG-OFCSS) records the anatomical site, Gustilo-Anderson grade, Ganga tissue score, and required modifiers for contamination, vascular status, nerve injury, and timing or system readiness. This approach produces a structured classification code rather than a single label. For example: Tibia shaft / GA-IIIB / GHOISS 16 / K2 V0 N1 T2. Conclusion: GG-OFCSS aims to integrate descriptive classification and prognostic scoring while retaining the Gustilo-Anderson and GHOISS systems. Prospective multicentre validation is needed to test reliability, infection rates, nonunion rates, flap needs, amputation rates, reoperation rates, and functional outcomes.
Keywords: open fracture, Gustilo-Anderson, Ganga Hospital Open Injury Severity Score, fracture classification
How to Cite?: Dr. Nishant, "The Modified Gustilo-Ganga Multidomain Open Fracture Classification and Severity Score: A Literature-Based Proposal for Unified Descriptive and Prognostic Documentation of Open Extremity Fractures", Volume 15 Issue 7, July 2026, International Journal of Science and Research (IJSR), Pages: 883-891, https://www.ijsr.net/getabstract.php?paperid=SR26704092844, DOI: https://dx.doi.org/10.21275/SR26704092844