Unified classification of open fractures: Based on Gustilo and OTA classification schemes.

Abstract

The Orthopaedic Trauma Association (OTA) classification scheme for open fractures has improved precision, validity and reliability over the modified Gustilo classification system. However, it needs to be modified into a simple and practical classification system to gain widespread acceptance and application. We devised a new "unified" classification of open fractures based on the Gustilo and OTA classification systems. The new classification was tested for interobserver reliability on five different fractures classified by 15 surgeons each using the Krippendorff's alpha. Preference of surgeons for the Gustilo, OTA and unified classifications was assessed. The new classification showed excellent interobserver reliability (α = 0.93). A significantly higher number of surgeons expressed preference for the new over the Gustilo and OTA classifications for routine clinical use. The new "unified" classification of open fractures has good validity, reliability and acceptability, and has the potential to replace all other existing classification systems.