title: 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?
  
  
  METHODS
  Retrospective observational cohort study; Level IV evidence.
  
  
  METHODS
  Level I trauma center and urban safety-net institution.
  
  
  METHODS
  Consecutive adult patients with open long bone fractures who underwent operative treatment between January 1, 2007 and December 31, 2012.
  
  
  METHODS
  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.affiliation: *Department of Orthopaedics, Denver Health Medical Center, School of Medicine, University of Colorado, Denver, CO; and †Department of Orthopaedic Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Republic of Korea.
authors.forename: Jiandong
authors.initials: J
authors.lastname: Hao
authors.forename: Derly O
authors.initials: DO
authors.lastname: Cuellar
authors.forename: Benoit
authors.initials: B
authors.lastname: Herbert
authors.forename: Ji Wan
authors.initials: JW
authors.lastname: Kim
authors.forename: Vivek
authors.initials: V
authors.lastname: Chadayammuri
authors.forename: Natalie
authors.initials: N
authors.lastname: Casemyr
authors.forename: Mark E
authors.initials: ME
authors.lastname: Hammerberg
authors.forename: Philip F
authors.initials: PF
authors.lastname: Stahel
authors.forename: David J
authors.initials: DJ
authors.lastname: Hak
authors.forename: Cyril
authors.initials: C
authors.lastname: Mauffrey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D000066491:Clinical Decision-Making; D015331:Cohort Studies; D003120:Colorado / Q000453:epidemiology; D005260:Female; D005597:Fractures, Open / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D007869:Leg Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D015995:Prevalence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D016879:Salvage Therapy / Q000706:statistics & numerical data*; D012680:Sensitivity and Specificity; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014600:Utilization Review; D055815:Young Adult