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Clinical Correlation of the Orthopaedic Trauma Association Open Fracture Classification (OTA-OFC) with Wound Closure and Soft Tissue Complications in Open Upper Extremity Fractures.

Research paper by Sara M SM Putnam, Jacquelyn J Dunahoe, Julie J Agel, Matthew R MR Garner

Indexed on: 21 Oct '20Published on: 21 Oct '20Published in: Journal of orthopaedic trauma



Abstract

To correlate domains of the Orthopaedic Trauma Association Open Fracture Classification (OTA-OFC) in open upper extremity injuries with type of definitive soft tissue closure, complication rates, and unanticipated return to the operating room for complication. Retrospective review of prospectively collected data. Level I trauma center. 234 consecutive open upper extremity fractures. Operative management of open upper extremity fractures. Type of definitive closure, 90-day wound complication, wound complication necessitating return to the operating room. 280 injuries were identified and 234 had sufficient data for analysis. 84% (196/234) of open wounds were closed primarily, 7% (16/234) required a skin graft, and 4% (9/234) required rotational or free flap. 13% (22/166) of those followed for 90 days had a wound complication, and 50% of those with complication required a return to the OR. All OTA-OFC classifications statistically significantly correlated with type of closure (p<0.001), with skin having a high correlation (r=0.79), muscle (r=0.49) and contamination (r=0.47) moderate correlations, and arterial (r=0.32) and bone loss (r=0.33) low correlations. OTA-OFC muscle classification was predictive of 90-day wound complication (OR 0.31, 95% CI 0.07-0.21). OTA-OFC domains correlated variably with return to the OR. OTA-OFC clinically correlates with definitive wound management and 90-day wound complication in open upper extremity fractures. OTA-OFC skin classification has a high correlation with type of definitive wound closure. OTA-OFC muscle was the only domain that correlated with 90-day wound complication and was predictive of 90-day wound complication. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.