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

Abstract

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.

• Authors: 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: Journal of orthopaedic trauma (J Orthop Trauma) Vol. 30 Issue 4 Pg. 194-8 (Apr 2016) ISSN: 1531-2291 [Electronic] United States
• PMID: 26569184 (Publication Type: Journal Article, Observational Study)

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Amputation, Surgical (statistics & numerical data)
• Clinical Decision-Making
• Cohort Studies
• Colorado (epidemiology)
• Female
• Fractures, Open (diagnosis, surgery)
• Humans
• Leg Injuries (diagnosis, epidemiology, surgery)
• Male
• Middle Aged
• Needs Assessment
• Prevalence
• Reproducibility of Results
• Retrospective Studies
• Risk Assessment (methods)
• Salvage Therapy (statistics & numerical data)
• Sensitivity and Specificity
• Trauma Severity Indices
• Treatment Outcome
• Utilization Review
• Young Adult