Prediction of tibial nonunion at the 6-week time point

Ross, Keir A.; O’Halloran, Kevin; Castillo, Renan C.; Coale, Max; Fowler, Justin; Nascone, Jason W.; Sciadini, Marcus F.; Lebrun, Christopher; Manson, Theodore T.; Carlini, Anthony R.; Jolissaint, Josef E.; O’Toole, Robert V.

doi:10.1016/j.injury.2018.07.033

Cited by 35 publications

(28 citation statements)

References 38 publications

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“…The RUST score has proven useful in acute tibia fractures guiding the expectations of patients and orthopaedic surgeons. 12 Our data show similar predictive value of the RUST score when applied to tibial nonunion. Patient and surgeon expectations regarding time to union and ultimate union can be guided using preoperative and postoperative RUST score.…”

Section: Cortex Scoresupporting

confidence: 74%

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Radiographic union score for tibia fractures predicts success with operative treatment of tibial nonunion

Christiano

Goch

Leucht

et al. 2019

Journal of Clinical Orthopaedics and Trauma

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Background: The purpose of this study is to evaluate the ability of preoperative and postoperative radiographic union scores for tibia fractures (RUST) to predict treatment success of tibia fracture nonunion. Materials and methods: Patients presenting for operative treatment of tibia fracture nonunion were enrolled in a prospective data registry. Enrolled patients were followed at regular intervals for 12 months. Preoperative and 12 week postoperative radiographs were reviewed and scored using the RUST criteria. Postoperative time to union was determined by clinical and radiographic measures. Multivariate regressions were conducted to predict time to union using preoperative and postoperative RUST while controlling for treatment method. Receiver operating characteristic (ROC) curve was conducted to determine the accuracy of preoperative RUST in predicting failure of treatment. Results: Sixty-eight patients with aseptic tibia fracture nonunion treated operatively were identified. Sixty-one patients achieved union. Mean preoperative RUST was 7.5 (SD 1.4). Mean postoperative RUST was 9.2 (SD 1.4). Multivariate linear regressions demonstrated that preoperative (p ¼ 0.043) and postoperative (p ¼ 0.007) RUST are significant predictors of time to union after tibia fracture nonunion surgery. ROC curve demonstrated preoperative RUST below 7 was a good predictor of developing persistent tibia fracture nonunion (AUC ¼ 0.83, Sensitivity ¼ 1.000, Specificity ¼ 0.745). Conclusions: RUST preoperatively and postoperatively predicts outcome after nonunion surgery. RUST can be used as part of the complete clinical picture to shape patient expectations and guide treatment.

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Section: Cortex Scoresupporting

confidence: 74%

“…The RUST scoring system has proven to offer clinical guidance when applied to acute tibial shaft fractures. 12 Progressive radiographic union as shown by the RUST score correlates with improved gait. 13 The RUST score has also been used to predict nonunion after open wedge high tibial osteotomy.…”

Section: Discussionmentioning

confidence: 99%

Radiographic union score for tibia fractures predicts success with operative treatment of tibial nonunion

Christiano

Goch

Leucht

et al. 2019

Journal of Clinical Orthopaedics and Trauma

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“…This overrepresentation of patients with complications provides the likely explanation for a nonunion rate that is higher than most previous reports. However, the capacity of the RUST score to give consistent findings across distinct patient populations, as in this study and the abovementioned studies by Ross and Christiano, underscores the robustness of the threemonth RUST score as a prognostic tool for predicting nonunion [24]. Finally, our analysis was limited to the abovementioned four-predictor variables to prevent the over-fitting of our regression model.…”

Section: Discussionsupporting

confidence: 52%

“…The study determined that four predictors at six weeks (presence/absence of infection, RUST score, modified RUST score, and Non-union Risk Determination Score (NURD)), could generate a prediction model with both sensitivity and specificity for non-union of 82%. However, Ross et al utilized 40 variable inputs for 50 total non-union events, potentially over-fitting their model to their patient population [24].…”

Section: Discussionmentioning

confidence: 99%

Association of Three-Month Radiographic Union Score for Tibia Fractures (RUST) with Nonunion in Tibial Shaft Fracture Patients

Mundi

Axelrod

Chaudhry

et al. 2020

Cureus

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ObjectivesNonunions of tibial shaft fractures have profound implications on patient quality of life and are associated with physical and mental suffering. Radiographic Union Score for Tibia Fractures (RUST) may serve as an important prognostic tool for identifying patients at a high risk of nonunion. DesignWe used data from the Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures (SPRINT) and Fluid Lavage of Open Wounds (FLOW) trials to explore the association of three-month RUST scores with nonunion in patients with tibial shaft fractures treated with intramedullary nailing. We performed a retrospective cohort study nested within two multi-center, randomized controlled trials.

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“…Clinical and experimental studies have identified a number of potential factors that may help to predict fracture nonunion [ 15 – 18 ]. These factors include uncontrollable factors (for example, gender, age, underlying diseases, the way of injury) and controllable factors (for example, treatment method) [ 19 , 20 ]. The uncontrollable factors of tibial nonunion may be similar to those of other anatomic sites.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and influencing factors of nonunion in patients with tibial fracture: systematic review and meta-analysis

et al. 2020

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Objective The aim of this study is to assess the prevalence of nonunion in patients with tibia fracture and the association between influencing factors and tibia fracture nonunion. Method A database searches of PubMed, the Cochrane Library, EMBASE, China National Knowledge Infrastructure (CNKI), Weipu database, and Wanfang database from inception until June 2019 was conducted. The pooled prevalence, odds ratio (OR), and 95% confidence intervals (CI) were calculated with Stata software. Results In this study, 111 studies involving 41,429 subjects were included. In the study of the relationship between influencing factors and tibia fracture nonunion, 15 factors significantly influenced the fracture union, including > 60 years old, male, tobacco smoker, body mass index > 40, diabetes, nonsteroidal anti-inflammatory drugs (NSAIDs) user, opioids user, fracture of middle and distal tibia, high-energy fracture, open fracture, Gustilo-Anderson grade IIIB or IIIC, Müller AO Classification of Fractures C, open reduction, fixation model, and infection. Conclusion The prevalence of nonunion in patients with tibia fracture was 0.068 and 15 potential factors were associated with the prevalence. Closed reduction and minimally invasive percutaneous plate osteosynthesis (MIPPO) have the low risks of nonunion for the treatment of tibial fractures.

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Prediction of tibial nonunion at the 6-week time point

Cited by 35 publications

References 38 publications

Radiographic union score for tibia fractures predicts success with operative treatment of tibial nonunion

Radiographic union score for tibia fractures predicts success with operative treatment of tibial nonunion

Association of Three-Month Radiographic Union Score for Tibia Fractures (RUST) with Nonunion in Tibial Shaft Fracture Patients

Prevalence and influencing factors of nonunion in patients with tibial fracture: systematic review and meta-analysis

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