Value of a radiographic score for the assessment of healing of nailed femoral and tibial shaft fractures: A retrospective preliminary study

Perlepe, Vasiliki; Cerato, Andrea; Putineanu, Dan Constantin; Bugli, Céline; Heynen, G; Omoumi, Patrick; Berg, Bruno

doi:10.1016/j.ejrad.2017.10.020

Cited by 20 publications

(19 citation statements)

References 24 publications

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“…This study also suggests some potential difficulties with the widely used RUST score. Our RUST scores intra-class correlation coefficient (ICC = 0.727) was comparable to the RUST repeatability recently reported by many other investigators, 9,10,22,23,28,29 but was not as good as the original reports. 8 Notably, none of these reports show that RUST scoring meets the strictest definition of ICC>0.9 for an assessment to be deemed "reasonable for clinical measurements", 30 even in studies using simple transverse osteotomies in animal models.…”

Section: Discussionsupporting

confidence: 89%

Virtual Mechanical Testing from Low-Dose CT Scans Predicts Tibial Fracture Time to Union and Outperforms Subjective Outcomes Scoring

Schwarzenberg¹,

Dailey²

2018

Preprint

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Background: Quantitative outcomes assessment remains a persistent challenge in orthopaedic trauma. Although patient-reported outcomes measures (PROMs) and radiographic assessments such as RUST scores are frequently used, very little evidence has been presented to support their validity for measuring structural bone formation or biomechanical integrity.Methods: A sequential cohort of tibial shaft fracture patients was prospectively recruited for observation following standard reamed intramedullary nailing in a Level I trauma center. Follow-ups at 6, 12, 18, and 24 weeks included X-rays and completion of PROMs (EQ-5D and pain scores). Low-dose computed-tomography (CT) scans were also completed at 12 weeks. Scans were reconstructed in 3D and subjected to virtual mechanical testing via the finite element method to assess fracture limb torsional rigidity relative to intact bone.Results: Patients reported progressive longitudinal improvement in mobility, self-care, activity, and health over time, but the PROMs were not correlated with structural bone healing. RUST scoring showed moderate intra-rater agreement (ICC = 0.727), but the scores at 12 weeks were not correlated with time to union (R2 = 0.103, p = 0.193) and were only moderately correlated with callus structural integrity (R2 = 0.346, p = 0.010). In contrast, patient-specific virtual torsional rigidity (VTR) was significantly correlated with time to union (R2 = 0.383, p = 0.005) and clearly differentiated one case of delayed union (VTR = 10%, union at 8 months) from the rest of the normally healing cohort (VTR > 60%, median union time 19 weeks) using CT data alone.Conclusions: PROMs provide insight into the natural history of the patient experience after tibial fracture, but have limited utility as a measure of structural bone healing. RUST scoring, although repeatable, is not a valid longitudinal predictor of time to union. In contrast, virtual mechanical testing from low-dose CT scans provides a quantitative and objective structural callus assessment that reliably predicts time to union and may enable early diagnosis of compromised healing.Level of Evidence: Diagnostic Level II.

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Section: Discussionsupporting

confidence: 89%

Virtual Mechanical Testing from Low-Dose CT Scans Predicts Tibial Fracture Time to Union and Outperforms Subjective Outcomes Scoring

Schwarzenberg¹,

Dailey²

2018

Preprint

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“…The grade of bone consolidation was evaluated routinely after 6, 12 and 24 weeks after surgery. The grading was grouped by the mRUS [11]. The full grade of consolidation (mRUS = 16) was seen in five individuals at all four cortices during follow-up.…”

Section: Results Of Own Case Seriesmentioning

confidence: 99%

“…According to the score description, a value of 8.5 can be interpreted as a bone consolidation "in process" during the early bone remodeling phase (1-6 months). We emphasize that we report on a relatively short follow-up time of a mean of 14.9 months [11]. According to this radiological score, the full continuous and remodeled bone would result in a maximum of 16 (4 × 4) points.…”

Section: Bone Healingmentioning

confidence: 88%

“…The total number of surgeries, negative pressure wound therapy (NPWT) treatments and complications (prolonged wound secretion of antibiotic-eluting ceramic bone substitute, recurrence of infection) were collected. Bone consolidation during the follow-up was classified by a "modified radiographic union score (mRUS)", which quantitatively evaluates the healing process and bone formation of four cortices in AP and lateral radiographic view (maximum bone healing 4 × 4 points) [11]. The nature of the study was a descriptive case series with no control group.…”

Section: Case Seriesmentioning

confidence: 99%

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Treatment of fracture-related infection of the lower extremity with antibiotic-eluting ceramic bone substitutes: case series of 35 patients and literature review

et al. 2020

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Introduction The current treatment concepts of fracture-related infection (FRI) [Consensus Conference (Anti-Infection Task Force (AITF)) on the definition of acute or chronic osteomyelitis (cOM)] are associated with unsolved challenges and problems, underlining the need for ongoing medical research. Method Literature review of treatments for FRI and description of own cases. Results We could include eight papers with 394 patients reporting treatments and outcome in FRI. The infection was resolved in 92.9% (mean) of all treatments. The mean follow-up was 25 months with a persistent non-union in 7% of the patients. We diagnosed 35 (19f/16m; 56.4 ± 18.6 years) patients with bone infections anatomically allocated to the proximal and distal femur (12×), the pelvis (2×), distal tibia (3×), tibial diaphysis (11×), the ankle joint (4×) and calcaneus (3×). These 35 patients were treated (1) with surgical debridement; (2) with antibiotic-eluting ceramic bone substitutes; (3) bone stabilization (including nail fixation, arthrodesis nails, plates, or external ring fixation), (4) optionally negative pressure wound therapy (NPWT) and (5) optionally soft tissue closure with local or free flaps. The mean follow-up time was 14.9 ± 10.6 months (min/max: 2/40 month). The overall recurrence rate is low (8.5%, 3/35). Prolonged wound secretion was observed in six cases (17.1%, 6/35). The overall number of surgeries was a median of 2.5. Conclusion The results in the literature and in our case series are explicitly promising regarding the treatment of posttraumatic fracture-related infection.

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“…After the surgery, the displacement of proximal and distal fragments was measured to evaluate reduction quality, and the modi ed radiograph union score for tibias (mRUST) [20][21] was used to assess bone healing. The mRUST was evaluated at 1, 3, 6, 9, and 12 months after surgery.…”

Section: Data Collectionmentioning

confidence: 99%

Role of open cerclage wires used in patients with comminuted fractures of femoral shaft treated with intramedullary nails

Wang

Chuang

Kuan

et al. 2021

Preprint

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IntroductionThe role of open cerclage wiring in comminuted femoral shaft fracture treatment with intramedullary nails remains unclear. Here, we analyzed the effect of open cerclage wiring and the risk factors for nonunion after interlocking nailing in comminuted femoral shaft fracture treatment. We hypothesize that open cerclage wiring is applicable to patients with severe comminuted femoral shaft fractures without affecting bone healing.Patients and MethodsThis retrospective cohort study used data of consecutive patients who underwent interlocking nail fixation of a comminuted femoral shaft fracture between January 1, 2009, and December 31, 2016. First, eligible patients were divided into wire and no wire groups according to the surgical technique used and their union rate was recorded. The patients were then divided into union and nonunion groups and their perioperative data were analyzed.ResultsIn total, 71 comminuted femoral shaft fractures treated with interlocking nail fixation were included: 38 fractures (53.5%) augmented with the open wiring technique and 33 reduced with closed or mini–open wound without wiring. The wire group demonstrated significant improvements in fracture reduction compared with the no wire group, whereas no significant difference was observed in the union rate between the wire and no wire groups (p = 0.180). Moreover, 46 (65%) of 71 fractures united smoothly, and no significant difference was observed in any perioperative data between union and nonunion groups.DiscussionAugmented open cerclage wiring is indicated for comminuted femoral shaft fractures treated with intramedullary nails, even when the fragments are large or far displaced. Thus, open cerclage wiring can be used for fracture treatment, without decreasing the union rate.

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Value of a radiographic score for the assessment of healing of nailed femoral and tibial shaft fractures: A retrospective preliminary study

Cited by 20 publications

References 24 publications

Virtual Mechanical Testing from Low-Dose CT Scans Predicts Tibial Fracture Time to Union and Outperforms Subjective Outcomes Scoring

Virtual Mechanical Testing from Low-Dose CT Scans Predicts Tibial Fracture Time to Union and Outperforms Subjective Outcomes Scoring

Treatment of fracture-related infection of the lower extremity with antibiotic-eluting ceramic bone substitutes: case series of 35 patients and literature review

Role of open cerclage wires used in patients with comminuted fractures of femoral shaft treated with intramedullary nails

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