• Julie Agel, Andrew R Evans, John Lawrence Marsh, Thomas A Decoster, Douglas W Lundy, James F Kellam, Clifford B Jones, and Gregory L Desilva.
• Department of Orthopaedic Surgery and Sports Medicine, Harborview Medical Center, Seattle, WA 98104-2499, USA. bagel@u.washington.edu
• J Orthop Trauma. 2013 Jul 1; 27 (7): 379-84; discussion 384-5.

ObjectivesTo determine the reliability of the Orthopaedic Trauma Association (OTA) Open Fracture Classification.DesignVideo-based reliability study.SettingOrthopedic meetings and grand rounds.Patients/ParticipantsOrthopedic surgeons.InterventionNone.Main Outcome MeasurementsInterobserver reliability assessment classification.ResultsThe 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.ConclusionsThis 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.

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