• A Ghoshal, N Enninghorst, K Sisak, and Z J Balogh.
• John Hunter Hospital, Lookout Road, New Lambton Heights NSW 2305, Australia.
• Bone Joint J. 2018 Feb 1; 100-B (2): 242-246.

AimsTo evaluate interobserver reliability of the Orthopaedic Trauma Association's open fracture classification system (OTA-OFC).Patients And MethodsPatients 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.ResultsThe overall interobserver agreement was ĸ = 0.44 for the GA classification and ĸ = 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, ĸ = 0.55 (moderate); for muscle, ĸ = 0.44 (moderate); for arterial injury, ĸ = 0.74 (substantial); for contamination, ĸ = 0.35 (fair); and for bone loss, ĸ = 0.41 (moderate).ConclusionAlthough 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. Cite this article: Bone Joint J 2018;100-B:242-6.©2018 The British Editorial Society of Bone & Joint Surgery.

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