Journal article
Optimising the Orthopaedic Trauma Society Open Fracture Classification system: a proposal for modification in the context of high civilian gunshot fractures
- Abstract:
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Objectives
Uniformly classifying long bone open fractures is challenging. The purpose of this study was to propose a modified Orthopaedic Trauma Society (OTS) Open Fracture Classification System, developed in a setting with a high incidence of civilian gunshot fractures.
MethodsFrom our prospectively collected database, we identified all patients with open tibia and femur fractures treated with intramedullary nailing over a 4 year period. All open fractures were retrospectively reclassified from the Gustilo-Anderson Classification system to the OTS Open Fracture Classification System.
ResultsOne hundred and thirty-seven cases were identified. Ninety per cent of subjects were males. Their mean age was 34 years. The most common mechanism of injury was low-velocity civilian gunshot wounds (GSW) in 54.7% of cases. Soft tissue management was primary closure in 23.4% and soft tissue reconstruction in 24.1%. In 52.6% of cases (these all being secondary to civilian GSW), soft tissue management was healing via secondary intention. This is not included as a soft tissue management option in the OTS classification system. Fracture reclassification using the OTS Open Fracture Classification System was only possible in 47.5% of cases (Simple in 23.4%, Complex B in 24.1%).
ConclusionWe conclude that the OTS Open Fracture Classification System is not inclusive of all open tibia and femur fractures as it does not cater for gunshot fractures. We propose a modification as follows: alter ‘wound debridement’ to ‘appropriate wound care’ and to subcategorise ‘Simple’ into type A and B: healing via secondary intention and primary closure, respectively.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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(Preview, Version of record, pdf, 741.9KB, Terms of use)
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- Publisher copy:
- 10.1007/s00590-024-03853-6
Authors
- Publisher:
- Springer Nature
- Journal:
- European Journal of Orthopaedic Surgery and Traumatology More from this journal
- Volume:
- 34
- Issue:
- 3
- Pages:
- 1667-1674
- Place of publication:
- France
- Publication date:
- 2024-02-22
- Acceptance date:
- 2024-02-01
- DOI:
- EISSN:
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1432-1068
- ISSN:
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1633-8065
- Pmid:
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38386124
- Language:
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English
- Keywords:
- Pubs id:
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1655973
- Local pid:
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pubs:1655973
- Deposit date:
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2024-09-20
Terms of use
- Copyright holder:
- Lunga et al
- Copyright date:
- 2024
- Rights statement:
- © The Author(s) 2024. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.
- Licence:
- CC Attribution (CC BY)
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