Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, 500 University Drive, H089, Hershey, PA, 17033, USA.
McGovern Medical School At UTHealth, Houston, TX, USA.
Arch Orthop Trauma Surg. 2022 Dec;142(12):3599-3603. doi: 10.1007/s00402-021-03954-5. Epub 2021 May 16.
It was the goal of this study to determine if the Orthopaedic Trauma Association Open Fracture Classification (OTA-OFC) correlates with complication rates and to determine if it can be used as a predictive tool in the treatment of open tibial shaft fractures.
Retrospective review from two high-volume level 1 trauma centers of open tibial shaft fractures over a 5 year period. Variables of interest included OTA-OFC, type of wound closure, 90-day wound complication, unplanned re-operation, non-union, and amputation.
501 consecutive open tibial shaft fractures. 57.3% (n = 287) were closed primarily; local soft tissue advancement/rotational flap was used in 9.6% (n = 48); free soft tissue transfer used in 22.8% (n = 114); 8.6% (n = 43) required amputation. Of those followed for 90 days (n = 419), 45 (9.0%) had a wound complication, of which 40 (8%) required an unplanned reoperation. 40 (8.0%) patients went on to a documented non-union. All OTA-OFC classification groups significantly correlated with type of definitive closure (r = 0.18-0.81, p < 0.05) with OTA-OFC skin showing the strongest correlation (r = 0.81). OTA-OFC bone loss weakly correlated with wound complication (r = 0.12, p = 0.02) and no OTA-OFC classification correlated with the need for an unplanned secondary procedure. OTA-OFC skin, muscle and arterial all weakly correlated with non-union (r = 0.18-0.25, p < 0.05). OTA-OFC muscle was predictive of non-union (OR = OR = 2.2, 95% CI = 1.2-4.1) and amputation (OR 9.3, 95% CI = 3.7-23.7). OTA-OFC arterial was also predictive of amputation (OR 4.8, 95% CI = 2.5-9.3).
The OTA-OFC correlates variably with the type of definitive closure, the development of a 90-day wound complication, and the occurrence of a non-union. Importantly, OTA-OFC muscle classification is predictive of non-union while both OTA-OFC muscle and arterial were predictive of amputation.
本研究旨在确定骨科创伤协会开放性骨折分类（OTA-OFC）是否与并发症发生率相关，并确定其是否可作为开放性胫骨骨干骨折治疗的预测工具。
回顾性分析了 2 家高容量 1 级创伤中心 5 年内的开放性胫骨骨干骨折患者。感兴趣的变量包括 OTA-OFC、伤口闭合类型、90 天伤口并发症、计划外再次手术、骨不连和截肢。
501 例连续开放性胫骨骨干骨折。57.3%（n=287）行一期闭合；局部软组织推进/旋转皮瓣应用于 9.6%（n=48）；游离软组织转移应用于 22.8%（n=114）；8.6%（n=43）需要截肢。在随访 90 天的患者中（n=419），45 例（9.0%）发生伤口并发症，其中 40 例（8%）需要计划外再次手术。40 例（8.0%）患者发生了有记录的骨不连。所有 OTA-OFC 分类组与确定性闭合类型显著相关（r=0.18-0.81，p<0.05），OTA-OFC 皮肤相关性最强（r=0.81）。OTA-OFC 骨丢失与伤口并发症弱相关（r=0.12，p=0.02），且无 OTA-OFC 分类与计划外二次手术相关。OTA-OFC 皮肤、肌肉和动脉与骨不连均弱相关（r=0.18-0.25，p<0.05）。OTA-OFC 肌肉与非愈合（OR=2.2，95%CI=1.2-4.1）和截肢（OR 9.3，95%CI=3.7-23.7）相关。OTA-OFC 动脉与截肢（OR 4.8，95%CI=2.5-9.3）相关。
OTA-OFC 与确定性闭合类型、90 天伤口并发症的发生以及骨不连的发生存在一定相关性。重要的是，OTA-OFC 肌肉分类与骨不连相关，而 OTA-OFC 肌肉和动脉均与截肢相关。
