S Vetrivel Chezian Sengodan, V Arun, S Arun
Insitute of Orthopaedics and Traumatology, Coimbatore Medical College and Hospital, Tamil Nadu Dr. MGR Medical University, Tamil Nadu, India
Background: Open fractures with severe soft-tissue injuries are clinically challenging to treat. While several scoring systems are available to grade these clinical conditions, the Gustilo Anderson grading system is most commonly used. This grading system neither offers any clue regarding salvaging open fractures of Grade III B and above, nor does it help the surgeon to assess the outcomes in such injuries. Hence, a new system of grading was assessed to address this deficiency. Materials and Methods: Five hundred and twelve open fracture cases were analyzed for this study. Two hundred and twenty-seven patients sustained Grade III injuries according to the Gustilo Anderson classification; Of these, 175 patients had Grade III A open fractures and 52 patients were of Grade III B and above. The 52 patients with open fractures of Grade III B and above were scored using mangled extremity severity score (MESS), Ganga score, and our novel scoring system. The accuracy in deciding amputation and predict outcomes were measured. Results: The scores assessed by the new scoring system were compared with MESS, Gustilo grading, and Ganga score system. Binary logistic regression analysis indicated our scoring system to be more accurate compared to all other scoring systems (P = 0.02). A receiver operating characteristic curve was plotted to compare all other scoring systems. The area under the curve (0.996 ± 0.003) for our scoring system was significantly higher with the less standard error of the mean than other scoring systems compared. Conclusions: Our new scoring system was more accurate in predicting limb salvage and outcomes compared to the existing scoring systems for open fractures of Grade III B and above.
Keywords: Ganga score, Gustilo Anderson classification, Mangled extremity severity score, open fractures