Yesterday, I wrote about the classic Gustilo and Anderson open fracture classification system. Today, I’ll explain the newer classification system proposed by the Orthopaedic Trauma Association (OTA).

The OTA developed this system using both good and not so good methodology: literature review and panel consensus. It offered an opportunity to refine definitions to try to make the system as useful as possible. It evaluates 5 pathoanatomic factors and provides 3 subgroupings for each factor. Here’s the rundown:

Skin:

1. Can be approximated
2. Cannot be approximated
3. Degloved

Muscle: 

1. No appreciable muscle necrosis, or some injury with function intact
2. Loss of muscle but remains functional, or localized necrosis in injured area that requires excision
3. Dead muscle, loss of function, partial or complete compartment excision, complete disruption of muscle-tendon unit, muscle injury not approximatable

Arterial:

1. No injury
2. Injury, no ischemia
3. Injury with distal ischemia

Contamination:

1. None or minimal
2. Surface, easily removed and not embedded in deeper tissues
3. a. embedded in bone or deep tissues, b. high risk environment (feces, contaminated water, etc.)

Bone loss:

1. None
2. Bone loss, but still some contact between proximal and distal fragments
3. Segmental bone loss

The authors recommend using this classification at the end of the surgical debridement for best accuracy. It was also disigned for simplicity to reduce variability between raters. 

Bottom line: Although it looks a bit clunky, this new OTA open fracture scoring system looks to be an improvement over the good old G&A. Expect to begin seeing research papers using this system in the near future. But it will take some time to build up the depth of experience with this system to be able to make good predictions on outcomes.

Related post: 

• Gustilo & Anderson open fracture classification

Reference: A new classification scheme for open fractures. J orthop Trauma 24(8):457-465, 2010.