Orthopaedic Research Unit, Division of Orthopaedic Surgery, Groote Schuur Hospital, University of Cape Town, H49 Old Main Building, Observatory, Cape Town, 7925, South Africa.
Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa.
Eur J Orthop Surg Traumatol. 2024 Apr;34(3):1667-1674. doi: 10.1007/s00590-024-03853-6. Epub 2024 Feb 22.
Uniformly classifying long bone open fractures is challenging. The purpose of this study was to propose a modified Orthopaedic Trauma Society (OTS) Open Fracture Classification System, developed in a setting with a high incidence of civilian gunshot fractures.
From our prospectively collected database, we identified all patients with open tibia and femur fractures treated with intramedullary nailing over a 4 year period. All open fractures were retrospectively reclassified from the Gustilo-Anderson Classification system to the OTS Open Fracture Classification System.
One hundred and thirty-seven cases were identified. Ninety per cent of subjects were males. Their mean age was 34 years. The most common mechanism of injury was low-velocity civilian gunshot wounds (GSW) in 54.7% of cases. Soft tissue management was primary closure in 23.4% and soft tissue reconstruction in 24.1%. In 52.6% of cases (these all being secondary to civilian GSW), soft tissue management was healing via secondary intention. This is not included as a soft tissue management option in the OTS classification system. Fracture reclassification using the OTS Open Fracture Classification System was only possible in 47.5% of cases (Simple in 23.4%, Complex B in 24.1%).
We conclude that the OTS Open Fracture Classification System is not inclusive of all open tibia and femur fractures as it does not cater for gunshot fractures. We propose a modification as follows: alter 'wound debridement' to 'appropriate wound care' and to subcategorise 'Simple' into type A and B: healing via secondary intention and primary closure, respectively.
对长骨开放性骨折进行统一分类具有挑战性。本研究旨在提出一种改良的骨科创伤协会（OTS）开放性骨折分类系统，该系统是在平民枪击骨折发生率较高的环境下开发的。
从我们前瞻性收集的数据库中，我们确定了所有在 4 年内接受髓内钉治疗的开放性胫骨和股骨骨折患者。所有开放性骨折均从 Gustilo-Anderson 分类系统回顾性重新分类为 OTS 开放性骨折分类系统。
共确定了 137 例病例。90%的受试者为男性。他们的平均年龄为 34 岁。最常见的损伤机制是低能民用枪击伤，占 54.7%。软组织管理采用一期闭合的占 23.4%，软组织重建的占 24.1%。在 52.6%的病例中（这些都是民用枪击伤的继发情况），软组织管理是通过二期愈合来实现的。在 OTS 分类系统中，这并不被视为软组织管理的选择。使用 OTS 开放性骨折分类系统对骨折进行重新分类，只有 47.5%的病例是可行的（简单型占 23.4%，复杂 B 型占 24.1%）。
我们得出结论，OTS 开放性骨折分类系统并不包括所有胫骨和股骨开放性骨折，因为它不包括枪击伤。我们提出如下修改：将“清创术”改为“适当的伤口护理”，并将“简单型”细分为 A 型和 B 型：分别通过二期愈合和一期闭合来实现愈合。
