Journal of orthopaedic trauma · 2026
The Orthopaedic Trauma Association Open Fracture Classification Predicts Flap-Related Complications in Severe Open Tibial Fractures.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Yoo Jason J, Reider Lisa, O'Hara Nathan N, Bosse Michael J, Gary Joshua L, Morshed Saam, Potter Benjamin K, Quinnan Stephen M, Castillo Renan C, Carlini Anthony R, Firoozabadi Reza, Karunakar Madhav A, O'Toole Robert V, Pensy Raymond A, METRC
Аннотация
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.
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.