Hannover Fracture Scale '98--re-evaluation and new perspectives of an established extremity salvage score.

Abstract Objective: as the treatment of open fractures has improved over the years, the prognosis of open fractures has also changed. Thus, a re-evaluation of the Hannover Fracture Score (HFS), first introduced in 1983, has become necessary. Design: retrospectively all parameters of the HFS were evaluated in 182 open fractures of the upper and lower extremity treated in our institution between June 1994 and 1996. Statistical means included multivariant analysis, ROC analysis, calculation of sensitivity, specificity and accuracy. Finally the HFS 98 was established, which is characterised by eight domains with a total score range from 0 to 22 points and a cut off point (amputation recommended) at a score ≥11. This score was then prospectively applied on another 87 open long bone fractures, treated during July 1996 and December 1997. Results: this validation of the HFS ‘98 revealed a sensitivity of 0.82 and a specificity of 0.99. In comparison the NISSSA and the MESS presented a lower sensitivity and same specificity based on the same study group. Conclusion: in conclusion the HFS ‘98 has become a reliable extremity salvage score with a fairly high positive predictive value of 0.99, which is applicable for all the open long bone fractures regardless of their location.