Open Fracture Classifications: Which System Is Best?

Description

In this presentation, Alex Trompeter from St George's, London, discusses classification systems for open fractures, questioning the adequacy of existing methods. He emphasizes the importance of continuously challenging established systems, particularly focusing on the Gustilo-Anderson classification system, which has been in use since the 1970s. Trompeter argues that the current classifications primarily measure outcomes based on infection rates rather than factors that matter to patients, such as their ability to return to work or overall functional status. The talk critiques the subjectivity inherent in existing systems, highlighting how descriptors like 'extensive' and 'severe' can vary between practitioners, leading to inconsistencies in classification and patient care.



Trompeter introduces the Orthopedic Trauma Society (OTS) classification system for open fractures, which divides fractures into 'simple' or 'complex' categories based on the ability for tension-free closure and other associated injuries. He presents data validating the OTS system, demonstrating its correlation with patient-reported outcomes, while noting that traditional infection rates did not correlate with modern fracture care outcomes. Trompeter concludes by advocating for a focus on outcomes-driven classifications and the importance of rigorous validation for future systems, encouraging attendees to reconsider their approaches to fracture classifications.

Specialties