Does the OTA Open Fracture Classification Predict the Need for Limb Amputation? A Retrospective Observational Cohort Study on 512 Patients

Jiandong Hao, Derly O Cuellar, Benoit Herbert, Ji Wan Kim, Vivek Chadayammuri, Natalie Casemyr, Mark E Hammerberg, Philip F Stahel, David J Hak, Cyril Mauffrey
Journal of Orthopaedic Trauma 2016, 30 (4): 194-8

BACKGROUND: Few studies have examined the utility of the Orthopaedic Trauma Association Open Fracture Classification (OTA-OFC) compared to the traditional Gustilo-Anderson classification for prediction of treatment outcomes in patients with open fractures. QUESTIONS/OBJECTIVES:: (1) How do the Gustilo-Anderson classification and OTA-OFC systems compare in accuracy of predicting limb amputation, infection, and need for soft tissue coverage? (2) Is there an OTA-OFC summative threshold score that may guide the discussion and decision-making with regard to limb salvage or amputation?

DESIGN: Retrospective observational cohort study; Level IV evidence.

SETTING: Level I trauma center and urban safety-net institution.

PATIENTS/PARTICIPANTS: Consecutive adult patients with open long bone fractures who underwent operative treatment between January 1, 2007 and December 31, 2012.

MAIN OUTCOME AND MEASUREMENTS: Postoperative complications of infection, early limb amputation, and requirement for soft-tissue procedures.

RESULTS: The study cohort comprised 512 patients with mean age 49.6 ± 14.9 years. Nineteen patients (3.7%) underwent amputation. The Gustilo-Anderson classification demonstrated no correlations with any of the primary outcome measures, while OTA-OFC summative scores significantly varied between all outcome comparison groups. The skin injury component of the OTA-OFC was an independent predictor of limb amputation (OR, 5.44; 95% CI, 2.37-12.47), and an OTA-OFC summative score of ≥10 best correlated with need for amputation (P < 0.001). Sensitivity and specificity of the reported model were 79% and 94%, respectively.

CONCLUSIONS: Our results should be interpreted with caution due to the retrospective nature of our study. Based on our data, the OTA-OFC is superior to the Gustilo-Anderson classification system for prediction of postoperative complications and treatment outcomes in patients with open long bone fractures. A summative threshold score of 10 seems to identify increased odds of successful limb salvage.

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