Compared with the standard radiographic union scale for tibia score, a modified score for this scale showed slightly higher intraclass correlation coefficients and had substantial agreement for the evaluation of metadiaphyseal fractures.
In the first part of the study, 12 orthopedic trauma surgeons used a modified radiographic union scale for tibia (RUST) score to evaluate the radiographs of 27 distal femur fractures treated with either with plate or retrograde nail fixation. The radiographs were taken at various stages of healing, and the surgeons were given the radiographs in random order and asked to determine fracture healing.
In the second part of the study, researchers reviewed the radiographic results of two multicenter, randomized trials that compared plate and nail fixation of 81 distal femur and 46 proximal tibia fractures. Using the modified RUST score, radiographs were scored by orthopedic surgeons at 24 trauma centers at 3 months, 6 months and 12 months postoperatively to determine fracture healing.
Researchers determined intraclass correlation coefficient with 95% confidence intervals for each cortex, the standard and modified RUST scores, and the assignment of union for part one data.
Paul Tornetta III
Results showed slightly higher intraclass correlation coefficients for the modified RUST score compared with the standard RUST score. Researchers found both modified and standard RUST scores had substantial agreement when nail fixation was studied and moderate agreement when plate fixation was studied.
Among all fractures, the average standard RUST score at union was 8.5 and the average modified RUST score was 11.4, according to results. Researchers noted a higher standard and modified RUST score among nails at union compared with plates. Although the intraclass correlation coefficient for union indicated moderate agreement at 0.53, the most reviewers assigned union for a standard RUST score of nine and a modified RUST score of 11, according to results. Researchers also found a score of 10 on the standard RUST and 13 on the modified RUST was considered as a united fracture by more than 90% of reviewers. – by Casey Tingle
Disclosure: The researchers report no relevant financial disclosures.