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

• Published in: Journal of orthopaedic trauma Vol. 30; no. 4; p. 194
• Main Authors: Hao, Jiandong, Cuellar, Derly O, Herbert, Benoit, Kim, Ji Wan, Chadayammuri, Vivek, Casemyr, Natalie, Hammerberg, Mark E, Stahel, Philip F, Hak, David J, Mauffrey, Cyril
• Format: Journal Article
• Language: English
• Published: United States 01.04.2016
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Amputation - utilization; Clinical Decision-Making; Cohort Studies; Colorado - epidemiology; Female; Fractures, Open - diagnosis; Fractures, Open - surgery; Humans; Leg Injuries - diagnosis; Leg Injuries - epidemiology; Leg Injuries - surgery; Male; Middle Aged; Needs Assessment; Prevalence; Reproducibility of Results; Retrospective Studies; Risk Assessment - methods; Salvage Therapy - utilization; Sensitivity and Specificity; Trauma Severity Indices; Treatment Outcome; Utilization Review; Young Adult
• ISSN: 1531-2291
• DOI: 10.1097/BOT.0000000000000479

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? Retrospective observational cohort study; Level IV evidence. Level I trauma center and urban safety-net institution. Consecutive adult patients with open long bone fractures who underwent operative treatment between January 1, 2007 and December 31, 2012. Postoperative complications of infection, early limb amputation, and requirement for soft-tissue procedures. 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. 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.