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Updated: Jul 20, 2026

Creating Rigidly Stabilized Fractures for Assessing Intramembranous Ossification, Distraction Osteogenesis, or Healing of Critical Sized Defects
Published on: April 11, 2012
An interobserver reliability comparison between the Orthopaedic Trauma Association's open fracture classification and
A Ghoshal1, N Enninghorst2, K Sisak1
1John Hunter Hospital, Lookout Road, New Lambton Heights NSW 2305, Australia.
The Orthopaedic Trauma Association
Area of Science:
- Orthopaedic trauma
- Surgical classification systems
Background:
- Open fractures require accurate classification for effective treatment.
- The Gustilo and Anderson (GA) system is widely used but has limitations.
- The Orthopaedic Trauma Association's open fracture classification (OTA-OFC) system offers more detail.
Purpose of the Study:
- To assess the interobserver reliability of the OTA-OFC system.
- To compare the reliability of OTA-OFC with the GA classification.
Main Methods:
- Eight orthopaedic surgeons evaluated open long bone fractures.
- Surgeons used both GA and OTA-OFC classifications.
- Interobserver agreement was measured using Cohen's kappa.
Main Results:
- Overall interobserver agreement was moderate for both GA (ĸ=0.44) and OTA-OFC (ĸ=0.49).
- OTA-OFC showed variable agreement across categories: skin (ĸ=0.55), muscle (ĸ=0.44), arterial injury (ĸ=0.74), contamination (ĸ=0.35), and bone loss (ĸ=0.41).
Conclusions:
- The OTA-OFC system demonstrates moderate interobserver reliability, similar to the GA classification.
- While more detailed, the OTA-OFC may require further refinement for optimal clinical use.
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