The OTA open fracture classification: A study of reliability and agreement

OBJECTIVES: To determine the reliability of the Orthopaedic Trauma Association (OTA) Open Fracture Classification. DESIGN: Video-based reliability study. SETTING: Orthopedic meetings and grand rounds. PATIENTS/PARTICIPANTS: Orthopedic surgeons. INTERVENTION: None. MAIN OUTCOME MEASUREMENTS: Interobserver reliability assessment classification. RESULTS: The results demonstrate the system to have high reliability and much improvement compared with published Gustilo-Anderson classification reliability studies. Overall interrater reliability (κ) values were highest for arterial injury, with near perfect agreement across all raters and within each value. Skin injury, bone loss, and contamination demonstrated moderate to substantial levels of agreement. Muscle injury had the most disagreement between raters but still demonstrating a fair level of interrater agreement, which is a level of agreement superior to the literature related to the Gustilo-Anderson classification. Levels of agreement were similar between attending surgeons and residents for all categories. CONCLUSIONS: This study, which included a diverse multicenter multinational cohort of orthopaedic surgeons and residents, of the OTA Open Fracture Classification demonstrated moderate to excellent interobserver reliability.