Reliability of the Radiographic Union Score for Tibial Fractures

Cekiç, Erman; Alıcı, Emin; Yeşìl, Murat

doi:10.3944/aott.2014.14.0026

Cited by 33 publications

(36 citation statements)

References 32 publications

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“…Occasionally, a patient continued to be followed, but the surgeon did not declare the patient formally healed. In those cases, an already established radiographic measure of healing-the Radiographic Union Score for Tibial fractures (RUST)-was used by the first author (KO) [9,28]. If the fracture had a RUST [ 10, it was considered healed.…”

Section: Methodsmentioning

confidence: 99%

Will My Tibial Fracture Heal? Predicting Nonunion at the Time of Definitive Fixation Based on Commonly Available Variables

O’Halloran

Coale

Costales

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Accurate prediction of tibial nonunions has eluded researchers. Reliably predicting tibial nonunions at the time of fixation could change management strategies and stimulate further research. Questions/purposes We asked (1) whether data from medical records, fracture characteristics, and radiographs obtained at the time of fixation would identify features predictive of tibial fracture nonunion; and (2) whether this information could be used to create a model to assess the chance of nonunion at the time of intramedullary (IM) nail fixation of the tibia. Methods We retrospectively reviewed all tibial shaft fractures treated at our center from 2007 to 2014. We conducted a literature review and collected data on 35 factors theorized to contribute to delayed bone healing. Patients were followed to fracture healing or surgery for nonunion. Patients with planned prophylactic nonunion surgery were excluded because their nonunions were anticipated and our focus was on unanticipated nonunions. Our cohort consisted of 382 patients treated with IM nails for tibial shaft fractures (nonunion, 56; healed, 326). Bivariate and multivariate regression techniques and stepwise modeling approaches examined the relationship between variables available at definitive fixation. Factors were included in our model if they were identified as having a modest to large effect size (odds ratio [ 2) at the p \ 0.05 level. Results A multiple variable logistic regression model was developed, including seven factors (p \ 0.05; odds ratio [ 2.0). With these factors, we created the Nonunion Risk Determination (NURD) score. The NURD score assigns 5 points for flaps, 4 points for compartment syndrome, 3 points for chronic condition(s), 2 points for open fractures, 1 point for male gender, and 1 point per grade of American Society of Anesthesiologists Physical Status and percent cortical contact. One point each is subtracted for spiral fractures and for low-energy injuries, which were found to be predictive of union. A NURD score of 0 to 5 had a 2% chance of nonunion; 6 to 8, 22%; 9 to 11, 42%; and[12, 61%. Conclusions The proposed nonunion prediction model (NURDS) seems to have potential to allow clinicians to better determine which patients have a higher risk of nonunion. Future work should be directed at prospectively validating and enhancing this model. Level of Evidence Level III, diagnostic study.

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Section: Methodsmentioning

confidence: 99%

Will My Tibial Fracture Heal? Predicting Nonunion at the Time of Definitive Fixation Based on Commonly Available Variables

O’Halloran

Coale

Costales

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…The standard RUST score is a radiographic assessment of fracture healing that has improved intra‐observer and inter‐observer reliability compared to other radiographic assessments . The RUST score provides an indication of the fracture healing on a continuous scale from 4 to 12 points.…”

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confidence: 99%

Correlation between RUST assessments of fracture healing to structural and biomechanical properties

Cooke

Hussein

Lybrand

et al. 2017

Journal Orthopaedic Research

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Radiographic Union Score for Tibia (RUST) and modified RUST (mRUST) are radiographic tools for quantitatively evaluating fracture healing using a cortical scoring system. This tool has high intra-class correlation coefficients (ICCs); however, little evidence has evaluated the scores against the physical properties of bone healing. Closed, stabilized fractures were made in the femora of C3H/HeJ male mice (8-12 week-old) of two dietary groups: A control and a phosphate restricted diet group. Micro-computed tomography (µCT) and torsion testing were carried out at post-operative days (POD) 14, 21, 35, and 42 (n = 10-16) per group time-point. Anteroposterior and lateral radiographic views were constructed from the µCT scans and scored by five raters. The raters also indicated if the fracture were healed. ICCs were 0.71 (mRUST) and 0.63 (RUST). Both RUST scores were positively correlated with callus bone mineral density (BMD) (r = 0.85 and 0.80, p < 0.001) and bone volume fraction (BV/TV) (r = 0.86 and 0.80, p < 0.001). Both RUST scores positively correlated with callus strength (r = 0.35 and 0.26, p < 0.012) and rigidity (r = 0.50 and 0.39, p < 0.001). Radiographically healed calluses had a mRUST ≥13 and a RUST ≥10 and had excellent relationship to structural and biomechanical metrics. Effect of delayed healing due to phosphate dietary restrictions was found at later time points with all mechanical properties (p < 0.011), however no differences found in the RUST scores (p > 0.318). Clinical relevance of this study is both RUST scores showed high correlation to physical properties of healing and generally distinguished healed vs. non-healed fractures. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:945-953, 2018.

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“…Radiography and multidetector CT (MDCT) have an established role in orthopaedic evaluation of the extremities, [1][2][3] especially in the trauma setting. 4 While MRI scans are considered a good alternative to radiographs, 5 frequently post-operative assessments of fracture healing need to be performed in the presence of metal hardware, 6 which produces significant artefacts on MRI and could prove challenging to interpret.…”

Section: Introductionmentioning

confidence: 99%

Image quality of cone beam computed tomography for evaluation of extremity fractures in the presence of metal hardware: visual grading characteristics analysis

Osgood

Thawait

Hafezi-Nejad

et al. 2017

BJR

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Objective: To evaluate image quality and interobserver reliability of a novel cone-beam CT (CBCT) scanner in comparison with plain radiography for assessment of fracture healing in the presence of metal hardware. Methods: In this prospective institutional review boardapproved Health Insurance Portability and Accountability Act of 1996-complaint study, written informed consent was obtained from 27 patients (10 females and 17 males; mean age 44 years, age range 21-83 years) with either upper or lower extremity fractures, and with metal hardware, who underwent CBCT scans and had a clinical radiograph of the affected part. Images were assessed by two independent observers for quality and interobserver reliability for seven visualization tasks. Visual grading characteristic (VGC) curve analysis determined the differences in image quality between CBCT and plain radiography.Interobserver agreement was calculated using Pearson's correlation coefficient. Results: VGC results displayed preference of CBCT images to plain radiographs in terms of visualizing (1) cortical and (2) trabecular bones; (3) fracture line; (4) callus formation; (5) bridging ossification; and (6) screw thread-bone interface and its inferiority to plain radiograph in the visualization of (7) large metallic side plate contour with strong interobserver correlation (p-value , 0.05), except for visualizing large metallic side plate contour. Conclusion: For evaluation of fracture healing in the presence of metal hardware, CBCT image quality is preferable to plain radiograph for all visualization tasks, except for large metallic side plate contours. Advances in knowledge: CBCT has the potential to be a good diagnostic alternative to plain radiographs in evaluation of fracture healing in the presence of metal hardware.

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Reliability of the Radiographic Union Score for Tibial Fractures

Abstract: The RUST scoring system appears to be a reliable tool for the evaluation of clinical outcomes in management of tibial fracture.

Cited by 33 publications

References 32 publications

Will My Tibial Fracture Heal? Predicting Nonunion at the Time of Definitive Fixation Based on Commonly Available Variables

Will My Tibial Fracture Heal? Predicting Nonunion at the Time of Definitive Fixation Based on Commonly Available Variables

Correlation between RUST assessments of fracture healing to structural and biomechanical properties

Image quality of cone beam computed tomography for evaluation of extremity fractures in the presence of metal hardware: visual grading characteristics analysis

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