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Updated: Mar 6, 2026
Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
Published on: November 8, 2024
Treatment of high-energy lower extremity trauma is explained by the Orthopaedic Trauma Association Open Fracture
Julie Agel1, Lisa Reider2, Saam Morshed3
1Department of Orthopedic Surgery, University of Washington Medicine-Harborview Medical Center, Seattle, WA.
Objectives:
To examine the association of Orthopaedic Trauma Association Open Fracture Classification (AO FC-OFC) designation for a specific high-energy lower extremity fracture with the need for 3 or more surgeries, soft -tissue closure with a flap, or amputation.
Design:
Secondary analysis of multicenter prospective observational study.
Setting:
Thirty-two Level 1 trauma centers.
Patient/Participants:
Adult patients admitted from July 2012 to October 2015 with open pilon, ankle, talus, calcaneus, foot crush, or blast injuries.
Main Outcome Measurements:
Multivariable regression analyses examined the association between the OTA-FC (contamination, bone loss, muscle, skin and arterial injury) with 3 or more trips to the OR before definitive fixation, soft-tissue closure with a flap, and amputation within 18 months of injury.
Results:
A total of 447 patients comprised the study population. In adjusted models, embedded contamination [odds ratio (OR) = 3.0, 95% confidence interval (CI): 1.54-5.99], functional muscle loss (OR = 2.6, 95% CI: 1.60-4.23), skin that cannot be approximated (OR = 10.0, 95% CI: 5.02-19.79), and degloving (OR = 5.9, 95% CI: 2.94-11.61) were significantly associated with 3+ OR trips. Embedded contamination (OR = 2.2, 95% CI: 1.00-4.86), skin that cannot be approximated (OR = 23.8, 95% CI: 11.73-48.12), and degloving (OR = 12.4, 95% CI: 5.87-26.05) were significantly associated with soft tissue closure with a flap. Dead muscle (OR = 12.9, 95% CI: 4.78-34.89), arterial injury with ischemia (OR = 12.0, 95% CI: 3.22-44.27), skin that cannot be approximated (OR = 2.4, 95% CI: 1.03-5.37), and degloving (OR = 3.0, 95% CI: 1.25-6.98) were significantly associated with amputation.
Conclusions:
The OTA-FC variables that were most important for predicting treatment intervention varied. The severity of skin injury was associated with all outcomes.
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