Does the OTA Open Fracture Classification (OTA-OFC) Predict Flap-Related Complications in Severe Open Tibial Fractures?

Friday, October 20, 2023

10:46 AM – 10:52 AM PST

Location: 4B

Presenting Author / Corresponding Author(s)

Jason J. Yoo, MD

Baltimore, Maryland, United States

Disclosure(s): No financial relationships to disclose

Co-Author(s)

Nathan N. O'Hara, PhD

Assistant Professor
University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center
Baltimore, Maryland, United States
MB

Michael J. Bosse, MD
Joshua L. Gary, MD

Chief of Orthopaedic Trauma Service
Keck School of Medicine of the University of Southern California
Los Angeles, California, United States
Saam Morshed, MD, PhD, MPH (he/him/his)

Professor of Orthopaedic Surgery, Epidemiology and Biostatistics
University of California, San Francisco
University of California, San Francisco
San Francisco, California, United States
BP

Benjamin K. Potter, MD
Stephen M. Quinnan, MD

Director of Orthopaedic Trauma and Amputee Reconstruction
Paley Orthopedic & Spine Institute
West Palm Beach, Florida, United States
RC

Renan C. Castillo, PhD

Professor
Johns Hopkins Bloomberg School of Public Health
Baltimore, Maryland, United States
AC

Anthony R. Carlini, MS

Senior Research Associate
Johns Hopkins Bloomberg School of Public Health
Johns Hopkins Bloomberg School of Public Health
Baltimore, Maryland, United States
Reza Firoozabadi, MD, MA

Associate Professor of Orthopedics and Sports Medicine
University of Washington, Harborview Medical Center
Seattle, Washington, United States
MK

Madhav A. Karunakar, MD

Atrium Health Carolinas Medical Center
RO

Robert V. O'Toole, MD

Professor, Orthopaedic Surgery
University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center
Baltimore, Maryland, United States
RP

Raymond A. Pensy, MD

University of Maryland Medical Center

Group Author(s)

GM

Group METRC

Purpose: It is unknown if the Orthopaedic Trauma Association Open Fracture Classification (OTA-OFC) improves upon the limited ability of the of the Gustilo-Anderson system to adequately describe the range of severity in injuries that require flap coverage. The purpose of this study was to evaluate the ability of the OTA-OFC to predict wound complications in patients with severe open tibial fractures who underwent local and free flap reconstruction. Our hypothesis was that higher OTA-OFC cumulative and subcomponent scores would be associated with increased flap-related complications.

Methods: This is a secondary analysis of data collected in FIXIT, a multicenter prospective trial comparing outcomes following internal fixation versus modern ring external fixators in patients with severe open tibial fractures. The study population included patients in both the randomized and observational arms who underwent local or free flap reconstruction. The primary outcome was hospital readmission or reoperation for a flap-related complication within 1 year of study enrollment. Logistic regression and omnibus tests were used to determine associations between OTA-OFC cumulative and subcomponent scores with complications.

Results: 258 patients underwent flap reconstruction; 71 patients underwent local flap and 187 underwent free flap reconstruction. Cumulative OTA-OFC averaged 9 points (range, 5–14) for both groups. Within patients treated with free flaps, a 1-point increase in the cumulative OTA-OFC was associated with a 35% increase in the odds of a flap-related complication (95% confidence interval, 1.1-1.6; P = 0.001). Within patients treated with local flaps, we observed a similar point estimate of 1.3 per 1-point increase but the association was not statistically significant (P = 0.15). Upon omnibus testing, subcomponent scores within skin (P = 0.02) and wound contamination (P = 0.01) were associated with increased flap-related complications within the free flap group and the arterial subcomponent score within the local flap group (P = 0.03).

Conclusion: The OTA-OFC appears to provide clinically useful data to help risk-stratify flap-related complications in patients undergoing flap reconstruction for severe open tibial fractures. Clinicians should be aware that the arterial, skin, and contamination subcomponent scores seem to provide particularly valuable information when predicting odds of flap-related complications in these complex patients.

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