Treatment of high-energy lower extremity trauma is explained by the Orthopaedic Trauma Association Open Fracture Classification.

Abstract

To examine the association of Orthopaedic Trauma Association Open Fracture Classification (AO FC-OFC) designation for a specific high-energy lower extremity fracture with the need for 3 or more surgeries, soft -tissue closure with a flap, or amputation. Secondary analysis of multicenter prospective observational study. Thirty-two Level 1 trauma centers. Adult patients admitted from July 2012 to October 2015 with open pilon, ankle, talus, calcaneus, foot crush, or blast injuries. Multivariable regression analyses examined the association between the OTA-FC (contamination, bone loss, muscle, skin and arterial injury) with 3 or more trips to the OR before definitive fixation, soft-tissue closure with a flap, and amputation within 18 months of injury. A total of 447 patients comprised the study population. In adjusted models, embedded contamination [odds ratio (OR) = 3.0, 95% confidence interval (CI): 1.54-5.99], functional muscle loss (OR = 2.6, 95% CI: 1.60-4.23), skin that cannot be approximated (OR = 10.0, 95% CI: 5.02-19.79), and degloving (OR = 5.9, 95% CI: 2.94-11.61) were significantly associated with 3+ OR trips. Embedded contamination (OR = 2.2, 95% CI: 1.00-4.86), skin that cannot be approximated (OR = 23.8, 95% CI: 11.73-48.12), and degloving (OR = 12.4, 95% CI: 5.87-26.05) were significantly associated with soft tissue closure with a flap. Dead muscle (OR = 12.9, 95% CI: 4.78-34.89), arterial injury with ischemia (OR = 12.0, 95% CI: 3.22-44.27), skin that cannot be approximated (OR = 2.4, 95% CI: 1.03-5.37), and degloving (OR = 3.0, 95% CI: 1.25-6.98) were significantly associated with amputation. The OTA-FC variables that were most important for predicting treatment intervention varied. The severity of skin injury was associated with all outcomes.