Reliability of RUST and Modified RUST Scores for the Evaluation of Union in Humeral Shaft Fractures Treated with Different Techniques

Mısır, Abdülhamit; Uzun, Erdal; Kızkapan, Turan Bilge; Yıldız, Kadir İlker; Önder, Murat; Özçamdallı, Mustafa

doi:10.1007/s43465-020-00182-8

Cited by 11 publications

(8 citation statements)

References 25 publications

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“…33 Reliability is greater with interlocking nail or external skeletal fixation, compared with bone plates, which can obscure the cortex. 30 In 10 of the 22 scores given here, the presence of bone plates prevented assessment of at least one cortex so we agree with Misir and colleagues 30 that plate fixation imposes limitations on the mRUST. However, in eight out of nine treatments mRUST observer 1 agreed with the attending clinician that the fractures had healed.…”

Section: Discussionsupporting

confidence: 70%

“…5 One previous retrospective review of canine tibial fractures used mRUST scoring to determine the time to union. 29 It is considered a reliable way of assessing fracture healing in the human tibia, humerus, forearm and femur 21,[30][31][32] and in tarsal arthrodesis. 33 Reliability is greater with interlocking nail or external skeletal fixation, compared with bone plates, which can obscure the cortex.…”

Section: Discussionmentioning

confidence: 99%

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Bioengineering an Osteoinductive Treatment for Bone Healing Disorders: A Small Animal Case Series

et al. 2023

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The aim of this article was to study clinical and radiographic outcomes following treatment of bone healing disorders with a novel osteoinductive system that utilizes poly (ethyl acrylate), fibronectin and an ultra-low concentration of recombinant human bone morphogenetic protein-2. A case series of nine dogs and two cats were treated, and clinical records and radiographs were reviewed. Radiographs were scored by two blinded observers using the modified Radiographic Union Score for Tibial Fractures. Long-term follow-up was obtained using the Canine Orthopaedic Index and Feline Musculoskeletal Pain Index. Follow-up data were available for 11 treatments (10 cases). Complications: three minor, three major, one catastrophic (non-union requiring amputation). Lameness median 320 (range: 42–1,082) days postoperatively: ‘sound’ (three cases), ‘subtle’ (two), ‘mild’ (three), ‘moderate’ (one), and ‘non-weightbearing’ (one). The attending clinician judged 9 of 11 treatments achieved radiographic union; modified Radiographic Union Score for Tibial Fractures observers 1 and 2 agreed with the clinician in 8/9 and 5/9 treatments respectively. Long-term Canine Orthopaedic Index scores for five dogs median 650 (range: 544–1,724) days postoperatively: 15/64 (median) for four dogs with acceptable outcomes, 30/64 in one dog with a poor outcome. Feline Musculoskeletal Pain Index scores for two cats 433 and 751 days postoperatively: 48/60 and 60/60. Eight of 10 cases were sound or showed subtle or mild lameness in the short- or long-term, and radiographic union occurred in the majority of treatments.

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Bioengineering an Osteoinductive Treatment for Bone Healing Disorders: A Small Animal Case Series

et al. 2023

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“…Bone healing on radiographs was analyzed using a modifica- tion of the radiological union scale in tibial fractures (mRUST) as published by Litrenta et al 18 This is a radiological scoring system assessing bone healing in a standardized manner on conventional radiographs in two planes, originally developed for tibia fractures 19 and later validated for the humerus. 20 Each cortex on the anteroposterior and lateral radiograph is scored as: 1 = no callus; 2 = callus present; 3 = bridging callus; and 4 = remodelled. All scores are summed up, resulting in a sum score ranging from 4 to 16.…”

Section: Radiographymentioning

confidence: 99%

Implant retention in a rabbit model of fracture-related infection

Puetzler,

Vallejo Diaz,

Gosheger

et al. 2024

Bone Joint Res

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AimsFracture-related infection (FRI) is commonly classified based on the time of onset of symptoms. Early infections (< two weeks) are treated with debridement, antibiotics, and implant retention (DAIR). For late infections (> ten weeks), guidelines recommend implant removal due to tolerant biofilms. For delayed infections (two to ten weeks), recommendations are unclear. In this study we compared infection clearance and bone healing in early and delayed FRI treated with DAIR in a rabbit model.MethodsStaphylococcus aureus was inoculated into a humeral osteotomy in 17 rabbits after plate osteosynthesis. Infection developed for one week (early group, n = 6) or four weeks (delayed group, n = 6) before DAIR (systemic antibiotics: two weeks, nafcillin + rifampin; four weeks, levofloxacin + rifampin). A control group (n = 5) received revision surgery after four weeks without antibiotics. Bacteriology of humerus, soft-tissue, and implants was performed seven weeks after revision surgery. Bone healing was assessed using a modified radiological union scale in tibial fractures (mRUST).ResultsGreater bacterial burden in the early group compared to the delayed and control groups at revision surgery indicates a retraction of the infection from one to four weeks. Infection was cleared in all animals in the early and delayed groups at euthanasia, but not in the control group. Osteotomies healed in the early group, but bone healing was significantly compromised in the delayed and control groups.ConclusionThe duration of the infection from one to four weeks does not impact the success of infection clearance in this model. Bone healing, however, is impaired as the duration of the infection increases.Cite this article: Bone Joint Res 2024;13(3):127–135.

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“…Patients were secondarily evaluated using the Radiographic Union Score for Tibial Fractures [radiographic union score in tibial (RUST)] which has been validated and shown to have high sensitivity, comparable with the modified RUST, when assessing fracture healing. 7,12,13,[30][31][32] Nonunion was defined as patients undergoing a secondary procedure for nonunion repair within 1 year after index surgery. 33,34 PROMIS PF and PROMIS PI scores were collected for all included patients until 1 year following index surgery, until nonunion repair, or until a subsequent surgery requiring bony work (ie, implant removal).…”

Section: Data Collectionmentioning

confidence: 99%

Patient-Reported Outcome Measurement Information Systems Physical Function and Pain Interference Scores Are Correlated With Tibial Shaft Fracture Nonunion Following Intramedullary Nailing

Dong,

Thorne,

Da Silva

et al. 2024

Journal of Orthopaedic Trauma

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Objective: To assess trends in PROMIS Physical Function (PF) and Pain Interference (PI) in surgically treated tibial shaft fracture patients progressing to union versus nonunion. Design: Retrospective cohort study Setting: Level 1 trauma center Patient Selection Criteria: Patients with operatively treated tibial shaft fractures (AO/OTA 42-A,B,C) using an intramedullary nail. Outcome Measures and Comparisons: PROMIS physical function and pain interference were compared between patients progressing to union and patients requiring nonunion repair. Results: A total of 234 patients (196 union, 38 nonunion) were included consisting 144 males and 90 females. The mean age of included patients was 40.8 years. A significant difference in mean PROMIS PF between union and nonunion patients was observed at 1-3 months (p=0.005), 3-6 months (p<0.001), 6-9 months (p=0.003), and 6-12 months (p=0.018). The odds of developing nonunion for every unit decrease in PROMIS PF was significant at 3-6 months (OR 1.07, p=0.028) and 6-9 months (OR 1.17, p=0.015). A significant difference in mean PROMIS PI between union and nonunion patients was observed at 1-3 months (p=0.001), 3-6 months (p=0.005), and 6-9 months (p=0.005). The odds of developing nonunion for every unit increase in PROMIS PI was significant at 1-3 months (OR 1.11, p=0.005), 3-6 months (OR 1.10, p=0.011), and 6-9 months (OR 1.23, p=0.011). Conclusion: Poorly trending PROMIS PF and PI in the clinical setting is a factor that can be used to evaluate progression to nonunion following tibial shaft repair where imaging studies may lag behind. Level of Evidence: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Reliability of RUST and Modified RUST Scores for the Evaluation of Union in Humeral Shaft Fractures Treated with Different Techniques

Cited by 11 publications

References 25 publications

Bioengineering an Osteoinductive Treatment for Bone Healing Disorders: A Small Animal Case Series

Bioengineering an Osteoinductive Treatment for Bone Healing Disorders: A Small Animal Case Series

Implant retention in a rabbit model of fracture-related infection

Patient-Reported Outcome Measurement Information Systems Physical Function and Pain Interference Scores Are Correlated With Tibial Shaft Fracture Nonunion Following Intramedullary Nailing

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