The Orthopaedic Trauma Association Open Fracture Classification Predicts Flap-Related Complications in Severe Open Tibial Fractures.

[OBJECTIVES] To determine the association between Orthopaedic Trauma Association Open Fracture Classification (OTA-OFC) scores and flap-related complications. The hypothesis was that higher OTA-OFC cumulative and subcomponent scores would be associated with increased flap-related complications.

[DESIGN] Retrospective cohort.

[SETTING] 20 US trauma centers.

[PATIENT SELECTION CRITERIA] The study population included patients aged 18-64 years who underwent flap reconstruction after a severe open tibial fracture (OTA/AO 41, 42, or 43).

[OUTCOME MEASURES AND COMPARISONS] The primary outcome was hospitalization 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 stratified by local or free flap reconstruction.

[RESULTS] Of the 258 included patients, 71 patients [male 58 (82%); median age 33 (IQR 23-51) years] underwent local flap reconstruction and 187 patients [male 160 (86%); median age 37 (IQR 26-47) years] underwent free flap reconstruction. The mean cumulative OTA-OFC was 9 points (range 5-14) for both cohorts. 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% CI, 1.14-1.63; P = 0.001). Among patients treated with local flaps, a 1-point increase was not associated with flap-related complications (OR 1.30; 95% CI, 0.92-1.73; P = 0.15). The odds of a flap complication varied significantly based on the wound contamination subcomponent score within the free flap group (omnibus P = 0.01) and the arterial subcomponent within the local flap group (omnibus P = 0.03).

[CONCLUSIONS] The OTA-OFC provided data that helped risk-stratify flap-related complications in patients undergoing flap reconstruction for severe open tibial fractures. The arterial and contamination subcomponent scores might provide particularly valuable information when predicting the odds of flap-related complications.

[LEVEL OF EVIDENCE] Prognostic, Level III. See Instructions for Authors for a complete description of levels of evidence.