Putnam Sara M, Dunahoe Jacquelyn, Agel Julie, Garner Matthew R
Department of Orthopaedic Surgery, University of Nebraska Medical Center, 985640 Nebraska Medical Center, Omaha, NE.
Department of Orthopaedic Surgery, Harborview Medical Center, Seattle, WA; and.
J Orthop Trauma. 2021 Jun 1;35(6):e184-e188. doi: 10.1097/BOT.0000000000001986.
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.
Two hundred thirty-four consecutive open upper extremity fractures.
Operative management of open upper extremity fractures.
Type of definitive closure, 90-day wound complication, and wound complication necessitating return to the operating room.
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.
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.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
探讨上肢开放性骨折的骨科创伤协会开放性骨折分类（OTA - OFC）各领域与最终软组织闭合类型、并发症发生率以及因并发症意外返回手术室情况之间的相关性。
对前瞻性收集的数据进行回顾性分析。
一级创伤中心。
234例连续的上肢开放性骨折患者。
上肢开放性骨折的手术治疗。
最终闭合类型、90天伤口并发症以及因伤口并发症需返回手术室的情况。
共识别出280处损伤，其中234例有足够数据用于分析。84%（196/234）的开放性伤口一期闭合，7%（16/234）需要植皮，4%（9/234）需要旋转或游离皮瓣。在随访90天的患者中，13%（22/166）出现伤口并发症，其中50%的并发症患者需要返回手术室。所有OTA - OFC分类与闭合类型在统计学上均有显著相关性（P < 0.001），其中皮肤相关性高（r = 0.79），肌肉（r = 0.49）和污染（r = 0.47）相关性中等，动脉（r = 0.32）和骨缺损（r = 0.33）相关性低。OTA - OFC肌肉分类可预测90天伤口并发症（比值比0.31，95%置信区间0.07 - 0.21）。OTA - OFC各领域与返回手术室的情况相关性各异。
OTA - OFC与上肢开放性骨折的最终伤口处理及90天伤口并发症在临床上具有相关性。OTA - OFC皮肤分类与最终伤口闭合类型高度相关。OTA - OFC肌肉是唯一与90天伤口并发症相关且可预测90天伤口并发症的领域。
预后性III级。有关证据级别的完整描述，请参阅作者指南。
