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

Objectives: 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. Design: Secondary analysis of multicenter prospective observational study. Setting: Thirty-two Level 1 trauma centers. Patient/Participants: Adult patients admitted from July 2012 to October 2015 with open pilon, ankle, talus, calcaneus, foot crush, or blast injuries. Main Outcome Measurements: 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. Results: 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. Conclusions: The OTA-FC variables that were most important for predicting treatment intervention varied. The severity of skin injury was associated with all outcomes.