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Evaluation of the orthopaedic trauma association open fracture classification (OTA-OFC) as an outcome prediction tool in open tibial shaft fractures

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

It was the goal of this study to determine if the Orthopaedic Trauma Association Open Fracture Classification (OTA-OFC) correlates with complication rates and to determine if it can be used as a predictive tool in the treatment of open tibial shaft fractures.

Materials and methods

Retrospective review from two high-volume level 1 trauma centers of open tibial shaft fractures over a 5 year period. Variables of interest included OTA-OFC, type of wound closure, 90-day wound complication, unplanned re-operation, non-union, and amputation.

Results

501 consecutive open tibial shaft fractures. 57.3% (n = 287) were closed primarily; local soft tissue advancement/rotational flap was used in 9.6% (n = 48); free soft tissue transfer used in 22.8% (n = 114); 8.6% (n = 43) required amputation. Of those followed for 90 days (n = 419), 45 (9.0%) had a wound complication, of which 40 (8%) required an unplanned reoperation. 40 (8.0%) patients went on to a documented non-union. All OTA-OFC classification groups significantly correlated with type of definitive closure (r = 0.18–0.81, p < 0.05) with OTA-OFC skin showing the strongest correlation (r = 0.81). OTA-OFC bone loss weakly correlated with wound complication (r = 0.12, p = 0.02) and no OTA-OFC classification correlated with the need for an unplanned secondary procedure. OTA-OFC skin, muscle and arterial all weakly correlated with non-union (r = 0.18–0.25, p < 0.05). OTA-OFC muscle was predictive of non-union (OR = OR = 2.2, 95% CI = 1.2–4.1) and amputation (OR 9.3, 95% CI = 3.7–23.7). OTA-OFC arterial was also predictive of amputation (OR 4.8, 95% CI = 2.5–9.3).

Conclusions

The OTA-OFC correlates variably with the type of definitive closure, the development of a 90-day wound complication, and the occurrence of a non-union. Importantly, OTA-OFC muscle classification is predictive of non-union while both OTA-OFC muscle and arterial were predictive of amputation.

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Authors and Affiliations

  1. Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, 500 University Drive, H089, Hershey, PA, 17033, USA

    Matthew R. Garner

  2. McGovern Medical School At UTHealth, Houston, TX, USA

    Stephen J. Warner & Jacob A. Heiner

  3. Icahn School of Medicine At Mount Sinai, New York, NY, USA

    Yesul T. Kim

  4. Department of Orthopaedics and Sports Medicine, Harborview Medical Center, Seattle, WA, USA

    Julie Agel

Authors
  1. Matthew R. Garner
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  2. Stephen J. Warner
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  3. Jacob A. Heiner
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  4. Yesul T. Kim
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  5. Julie Agel
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Correspondence to Matthew R. Garner.

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Conflict of interest

Dr. Garner receives research funding from (not related to this work) and is a board or committee member for the Orthopaedic Trauma Association. He is also a paid consultant for and receives research funding from Johnson and Johnson, DePuy, Synthes. Dr. Warner is a paid consultant for Johnson and Johnson, DePuy, Synthes. Julie Agel is a board or committee member for the Orthopaedic Trauma Association.

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Institutional Review Board approval was obtained at both institutions.

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Garner, M.R., Warner, S.J., Heiner, J.A. et al. Evaluation of the orthopaedic trauma association open fracture classification (OTA-OFC) as an outcome prediction tool in open tibial shaft fractures. Arch Orthop Trauma Surg 142, 3599–3603 (2022). https://doi.org/10.1007/s00402-021-03954-5

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  • DOI: https://doi.org/10.1007/s00402-021-03954-5

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