Clinical Correlation of the Orthopaedic Trauma Association Open Fracture Classification With Wound Closure and Soft-Tissue Complications in Open Upper Extremity Fractures

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.

Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.