Philip Khoury, Nina Hazra, Anthony DeMartino, Kevina Birungi-Huff, Gerard P Slobogean, Robert V O'Toole, Nathan N O'Hara
{"title":"在预测胫骨骨折相关感染方面，创伤骨科协会-开放性骨折分类 (OTA-OFC) 优于 Gustilo-Anderson 分类吗？","authors":"Philip Khoury, Nina Hazra, Anthony DeMartino, Kevina Birungi-Huff, Gerard P Slobogean, Robert V O'Toole, Nathan N O'Hara","doi":"10.1097/BOT.0000000000002907","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To investigate and compare the predictive ability of the Orthopaedic Trauma Association Open Fracture Classification (OTA-OFC) and the Gustilo-Anderson classification systems for fracture-related infections (FRI) in patients with open tibia fractures.</p><p><strong>Methods: </strong>Design: Retrospective cohort study.</p><p><strong>Setting: </strong>Academic trauma center.</p><p><strong>Patient selection criteria: </strong>Patients aged 16 years or older with an operatively treated open tibia fracture (OTA-OTA 41, 42, and 43) between 2010 and 2021.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was FRI. The OTA-OFC and the Gustilo-Anderson classifications were compared in their ability to predict FRI.</p><p><strong>Results: </strong>890 patients (mean age, 43 years [range, 17 to 96]; 75% male) with 912 open tibia fractures were included. 142 (16%) had an infection. The OTA-OFC was not significantly better at predicting FRI than the Gustilo-Anderson classification (area under the curve, 0.66 vs. 0.66; P = 0.89). The Gustilo-Anderson classification was a stronger predictor of FRI than any single OTA-OFC domain, explaining 72% of FRI variance. Only the addition of the OTA-OFC wound contamination domain to Gustilo-Anderson significantly increased the variance explained (72% vs. 84%, P = 0.04). Embedded contamination increased the risk of FRI by approximately 10% as the risk of FRI with embedded contamination was 16% for Type I or IIs, 26% for Type IIIAs, 45% for Type IIIBs, and 46% for Type IIICs.</p><p><strong>Conclusions: </strong>The more complex OTA-OFC system was not better than the Gustilo-Anderson classification system in predicting FRIs in patients with open tibia fractures. Adding embedded wound contamination to the Gustilo-Anderson classification system significantly improved its prognostic ability.</p><p><strong>Level of evidence: </strong>Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6000,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Is the Orthopaedic Trauma Association-Open Fracture Classification (OTA-OFC) Better than the Gustilo-Anderson Classification at Predicting Fracture-Related Infections in the Tibia?\",\"authors\":\"Philip Khoury, Nina Hazra, Anthony DeMartino, Kevina Birungi-Huff, Gerard P Slobogean, Robert V O'Toole, Nathan N O'Hara\",\"doi\":\"10.1097/BOT.0000000000002907\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>To investigate and compare the predictive ability of the Orthopaedic Trauma Association Open Fracture Classification (OTA-OFC) and the Gustilo-Anderson classification systems for fracture-related infections (FRI) in patients with open tibia fractures.</p><p><strong>Methods: </strong>Design: Retrospective cohort study.</p><p><strong>Setting: </strong>Academic trauma center.</p><p><strong>Patient selection criteria: </strong>Patients aged 16 years or older with an operatively treated open tibia fracture (OTA-OTA 41, 42, and 43) between 2010 and 2021.</p><p><strong>Outcome measures and comparisons: </strong>The primary outcome was FRI. The OTA-OFC and the Gustilo-Anderson classifications were compared in their ability to predict FRI.</p><p><strong>Results: </strong>890 patients (mean age, 43 years [range, 17 to 96]; 75% male) with 912 open tibia fractures were included. 142 (16%) had an infection. The OTA-OFC was not significantly better at predicting FRI than the Gustilo-Anderson classification (area under the curve, 0.66 vs. 0.66; P = 0.89). The Gustilo-Anderson classification was a stronger predictor of FRI than any single OTA-OFC domain, explaining 72% of FRI variance. Only the addition of the OTA-OFC wound contamination domain to Gustilo-Anderson significantly increased the variance explained (72% vs. 84%, P = 0.04). Embedded contamination increased the risk of FRI by approximately 10% as the risk of FRI with embedded contamination was 16% for Type I or IIs, 26% for Type IIIAs, 45% for Type IIIBs, and 46% for Type IIICs.</p><p><strong>Conclusions: </strong>The more complex OTA-OFC system was not better than the Gustilo-Anderson classification system in predicting FRIs in patients with open tibia fractures. Adding embedded wound contamination to the Gustilo-Anderson classification system significantly improved its prognostic ability.</p><p><strong>Level of evidence: </strong>Prognostic Level II. 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Is the Orthopaedic Trauma Association-Open Fracture Classification (OTA-OFC) Better than the Gustilo-Anderson Classification at Predicting Fracture-Related Infections in the Tibia?
Objectives: To investigate and compare the predictive ability of the Orthopaedic Trauma Association Open Fracture Classification (OTA-OFC) and the Gustilo-Anderson classification systems for fracture-related infections (FRI) in patients with open tibia fractures.
Methods: Design: Retrospective cohort study.
Setting: Academic trauma center.
Patient selection criteria: Patients aged 16 years or older with an operatively treated open tibia fracture (OTA-OTA 41, 42, and 43) between 2010 and 2021.
Outcome measures and comparisons: The primary outcome was FRI. The OTA-OFC and the Gustilo-Anderson classifications were compared in their ability to predict FRI.
Results: 890 patients (mean age, 43 years [range, 17 to 96]; 75% male) with 912 open tibia fractures were included. 142 (16%) had an infection. The OTA-OFC was not significantly better at predicting FRI than the Gustilo-Anderson classification (area under the curve, 0.66 vs. 0.66; P = 0.89). The Gustilo-Anderson classification was a stronger predictor of FRI than any single OTA-OFC domain, explaining 72% of FRI variance. Only the addition of the OTA-OFC wound contamination domain to Gustilo-Anderson significantly increased the variance explained (72% vs. 84%, P = 0.04). Embedded contamination increased the risk of FRI by approximately 10% as the risk of FRI with embedded contamination was 16% for Type I or IIs, 26% for Type IIIAs, 45% for Type IIIBs, and 46% for Type IIICs.
Conclusions: The more complex OTA-OFC system was not better than the Gustilo-Anderson classification system in predicting FRIs in patients with open tibia fractures. Adding embedded wound contamination to the Gustilo-Anderson classification system significantly improved its prognostic ability.
Level of evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
期刊介绍：
Journal of Orthopaedic Trauma is devoted exclusively to the diagnosis and management of hard and soft tissue trauma, including injuries to bone, muscle, ligament, and tendons, as well as spinal cord injuries. Under the guidance of a distinguished international board of editors, the journal provides the most current information on diagnostic techniques, new and improved surgical instruments and procedures, surgical implants and prosthetic devices, bioplastics and biometals; and physical therapy and rehabilitation.
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