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

Abstract

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.

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

“…More recently, Christiano et al demonstrated the utility of the RUST score in patients with aseptic tibial nonunion undergoing reoperation to promote healing. Amongst 68 patients presenting, a RUST score of less than 7 predicted persistent non-union even after secondary surgery (sensitivity 1, specificity 0.75) [25]. Lastly, a recent review by our group identified that functional status was a reliable predictor of tibial union [26].…”

Functional and Radiological Outcome Analysis of Osteoperiosteal Decortication Flap in Nonunion of Tibia

“…In the current study, the radiological union was evaluated by RUST score. e RUST scoring system, with its advent way back in 2010, has shown a formidable performance with excellent intra-and interrater reliability for grading union and predicting union in tibial shaft fractures [18][19][20][21]. For clinical evaluation, we chose the LEFS score.…”

“…e primary outcome measures were to analyze the radiological union and the functional status of the limb. e radiological union scale in tibial fractures (RUST) score was used for the estimation of radiological union, and the lower extremity functional scale (LEFS) was used for the assessment of functional status [18][19][20][21][22][23]. e RUST scoring system (range � 4-12) utilises X-rays in both anteroposterior and lateral views to assess union by documenting the bridging callus and visible fracture line in all four cortices.…”

Updates in postoperative imaging modalities following musculoskeletal surgery

“…Radiographic union score (RUS) and modified RUS were developed to overcome the subjective nature of visual, radiographic evaluation, and clinical correlation in patients with delayed or non-union. 14 Studies showed good interobserver agreement in validation studies, even in complex bone defects and in patients with co-morbidities. These are not routinely used in clinical practice and still suffer from the fundamental limitation of being semiquantitative and subjective.…”