Radiographic evaluations: Which are most effective to follow fracture healing?. (May 2020)

• Record Type: Journal Article
• Authors: Atwan, Yousif; Schemitsch, Emil H.
• Is Part Of: Injury. Volume 51(2020)Supplement 2
• Page Start: S18
• Page End: S22
• Publication Date: 2020-05
• Subjects: Fracture healing -- Nonunion -- Radiographic union -- Interobserver reliability -- Intraobserver reliability -- Score -- Tibial fracture -- Hip fracture; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2019.12.028
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: The NURD score was increasingly predictive of nonunion with decreasing RUST score. The advantages gained from CT scans can be attained with cheaper plain radiographs using RUST and modified RUST. A RUST score of 10 and modified RUST score of 15 may provide a threshold above which a plated bone may be considered "healed". RUSH <18 was associated with 100% specificity and a positive predictive value of 100% for radiographic nonunion. Abstract: The assessment of fracture healing is an imperative and fundamental clinical aspect within orthopaedics. Despite that, there have historically been non-reliable methods utilized to assess for fracture union and nonunion. In recent years, a number of radiographic assessment tools such as the Radiographic Union Score for Tibial fractures (RUST) and Radiographic Union Score for Hip fracture (RUSH) have been developed in order to improve the reliability of fracture assessment for union. These scores have not only increased the reliability of assessments but have also provided thresholds to aid in predicting nonunion as well as union. The nonunion risk determination (NURD) Score was also created to prognosticate these clinical presentations. With the large burdens of cost, lower quality of life and morbidity associated with fracture nonunion, these evaluation methods have provided orthopaedic surgeons with an improved ability to predict nonunion and assist in the management of patients. This review outlines the development, reliability testing as well as biomechanical validity testing associated with these scoring systems.