[Hannover Fracture Scale '98--reevaluation and new prospects for an established score system]

The Hannover Fracture Scale (HFS) was first introduced in 1983. As the treatment of open fractures has improved over the years, mainly due to new implants, the prognosis of open fractures has also changed. Thus a reevaluation of this limb salvage score has become necessary.

Retrospectively all parameters of the HFS were evaluated in 182 open fractures of the upper and lower extremity treated in our institution between June '94 and June '96. Statistical means included the multivariant analysis, ROC analysis, calculation of sensitivity, specify and accuracy for the criterion of primary amputation. Finally the HFS'98 was established, which is characterized by eight domains (bone loss, skin injury, muscle injury, wound contamination, neurology, periost stripping, local and systemic circulation), a total score range from 0-22 points and a cut off point (amputation recommended) at a score of > or = 11. This score was then prospectively applied on another 87 open long bone fractures, treated in our institution between July '96 and Dec. '97.

This validation of the HFS'98 revealed a sensitivity of 0.82 and a specify of 0.99. In comparison the NISSSA and the MESS presented a sensitivity and specify of 0.71, 0.99 and 0.82, 0.99 respectively based on data of the prospective study group. In addition the Gustilo classification for open fractures has been defined by certain score ranges of the HFS'98.

In conclusion the HFS'98 has become a reliable extremity salvage score with a fairly high positive predictive value of 0.99, which is applicable for all open long bone fractures regardless of their location.