A new classification scheme for open fractures

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Journal of Orthopaedic Trauma 2010, 24 (8): 457-64

OBJECTIVES: The purpose of this study was to propose a new classification system for open fractures developed by the Classification Committee of the Orthopaedic Trauma Association.

SETTING: Academic and Level I trauma center.

PATIENTS/PARTICIPANTS: Consecutive patients with open fractures.

MAIN OUTCOME MEASUREMENTS: Open fracture classification scale.

RESULTS: Evaluation of 34 factors identified through systematic literature review and ranking in order of importance by our panel resulted in consensus on five essential categories of open fracture severity assessment: skin injury, muscle injury, arterial injury, contamination, and bone loss. These categories were chosen with particular attention paid to avoiding redundancy with existing tools for assessment of fracture configuration. Evaluation of the system through prospective data collection revealed that the five categories were widely applicable to open fractures, but the subcategories of open fracture characteristics required alteration to reflect clinically important parameters for open fracture severity stratification. Skin injury was best assessed by its potential for approximation rather than laceration length. Muscle injury required quantitative and qualitative assessment of potential for function. The effects of arterial injury were most accurately assessed through distal limb ischemia. The depth and nature of contamination were important indicators of overall contamination significance. Bone loss was best assessed quantitatively.

CONCLUSIONS: The proposed Orthopaedic Trauma Association Classification of Open Fractures is a scientifically derived assessment tool for determining the severity of open fractures. This tool will require further testing to establish validity characteristics and determine its clinical use compared with existing open fracture classification systems.

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