TY - JOUR
T1 - Clinical Correlation of the Orthopaedic Trauma Association Open Fracture Classification with Wound Closure and Soft-Tissue Complications in Open Upper Extremity Fractures
AU - Putnam, Sara M.
AU - Dunahoe, Jacquelyn
AU - Agel, Julie
AU - Garner, Matthew R.
N1 - Funding Information:
S. M. Putnam is paid faculty for AO NorthAmerica. Garner reports research support from OTA and DePuy, Synthes, and is paid faculty for AO NorthAmerica. The remaining authors report no conflict of interest.
Publisher Copyright:
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2021/6/1
Y1 - 2021/6/1
N2 - Objectives: 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. Design: Retrospective review of prospectively collected data. Setting: Level I trauma center. Patients: Two hundred thirty-four consecutive open upper extremity fractures. Intervention: Operative management of open upper extremity fractures. Main outcome measurements: Type of definitive closure, 90-day wound complication, and wound complication necessitating return to the operating room. Results: Two hundred eighty injuries were identified, and 234 had sufficient data for analysis. Eighty-four percent (196/234) of open wounds were closed primarily, 7% (16/234) required a skin graft, and 4% (9/234) required rotational or free flap. Thirteen percent (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% confidence interval 0.07–0.21). OTA-OFC domains correlated variably with return to the OR. Conclusion: 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 the 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.
AB - Objectives: 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. Design: Retrospective review of prospectively collected data. Setting: Level I trauma center. Patients: Two hundred thirty-four consecutive open upper extremity fractures. Intervention: Operative management of open upper extremity fractures. Main outcome measurements: Type of definitive closure, 90-day wound complication, and wound complication necessitating return to the operating room. Results: Two hundred eighty injuries were identified, and 234 had sufficient data for analysis. Eighty-four percent (196/234) of open wounds were closed primarily, 7% (16/234) required a skin graft, and 4% (9/234) required rotational or free flap. Thirteen percent (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% confidence interval 0.07–0.21). OTA-OFC domains correlated variably with return to the OR. Conclusion: 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 the 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.
KW - open fracture
KW - open fracture classification
KW - open fracture complication
KW - open upper extremity fracture
KW - wound complication
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U2 - 10.1097/BOT.0000000000001986
DO - 10.1097/BOT.0000000000001986
M3 - Review article
C2 - 33079834
AN - SCOPUS:85106552227
SN - 0890-5339
VL - 35
SP - E184-E188
JO - Journal of Orthopaedic Trauma
JF - Journal of Orthopaedic Trauma
IS - 6
ER -