An interobserver reliability comparison between the Orthopaedic Trauma Association's open fracture classification and the Gustilo and Anderson classification

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Abstract

Aims

To evaluate interobserver reliability of the Orthopaedic Trauma Association's open fracture classification system (OTA-OFC).

Patients and Methods

Patients of any age with a first presentation of an open long bone fracture were included. Standard radiographs, wound photographs, and a short clinical description were given to eight orthopaedic surgeons, who independently evaluated the injury using both the Gustilo and Anderson (GA) and OTA-OFC classifications. The responses were compared for variability using Cohen's kappa.

Results

The overall interobserver agreement was κ = 0.44 for the GA classification and κ = 0.49 for OTA-OFC, which reflects moderate agreement (0.41 to 0.60) for both classifications. The agreement in the five categories of OTA-OFC was: for skin, κ = 0.55 (moderate); for muscle, κ = 0.44 (moderate); for arterial injury, κ = 0.74 (substantial); for contamination, κ = 0.35 (fair); and for bone loss, κ = 0.41 (moderate).

Conclusion

Although the OTA-OFC, with similar interobserver agreement to GA, offers a more detailed description of open fractures, further development may be needed to make it a reliable and robust tool.

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