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

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Abstract

Background

The study aimed to evaluate the agreement between the radiographic union scale (RUST) and modified RUST (mRUST) in humeral shaft fractures treated with different techniques, and the effect of surgeons’ experience and thresholds for determining bone union.

Materials and Methods

A total of 20 orthopedic surgeons reviewed and scored radiographs of 30 patients with humeral shaft fractures treated by external fixation, intramedullary nailing, and plating using the RUST and mRUST on the 0 day, 6 weeks, 12 weeks and 24 weeks follow-up radiographs. Bone healing, interrater agreement between RUST and mRUST scores, and the threshold for radiographic union were evaluated.

Results

The intraclass correlation coefficient (ICC) was slightly higher for the mRUST score than the RUST score (0.71 versus [vs.] 0.67). There was substantial agreement between the mRUST and RUST scores for external fixation (0.75 and 0.69, respectively) and intramedullary nailing (0.79 and 0.71); there was moderate agreement between them for plating (0.59 and 0.55). Surgeons with varying experience had a similar agreement for both scores and scores for each humeral cortex. The external fixation and intramedullary nailing group had higher RUST and mRUST scores than the plating group. The ICC for union was substantial (0.64; external fixation: 0.68, intramedullary nailing: 0.64, and plating: 0.61). More than 90% of the reviewers recorded scores of 10/12 for RUST and 13/16 for mRUST at the time of union.

Conclusions

RUST and mRUST scores can be used reliably for the evaluation of bony union in humeral fractures treated with an external fixator and intramedullary nailing. In cases of humeral plating, a more sensitive tool for evaluation of fracture union is needed.

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Funding

This study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Health Sciences University, Gaziosmanpasa Training and Research Hospital, Karayollari Mah. Osmanbey Cad. 621. Sk., Gaziosmanpasa, 34255, Istanbul, Turkey

    Abdulhamit Misir

  2. Department of Orthopaedics and Traumatology, Faculty of Medicine, Erciyes University, Kayseri, Turkey

    Erdal Uzun

  3. Department of Orthopaedics and Traumatology, Bursa Cekirge State Hospital, Bursa, Turkey

    Turan Bilge Kizkapan

  4. Department of Orthopaedics and Traumatology, Health Sciences University, Baltalimani Bone and Joint Diseases Training and Research Hospital, Istanbul, Turkey

    Kadir Ilker Yildiz & Murat Onder

  5. Department of Orthopaedics and Traumatology, Faculty of Medicine, Ahi Evran University, Kirsehir, Turkey

    Mustafa Ozcamdalli

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  1. Abdulhamit Misir
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  2. Erdal Uzun
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  3. Turan Bilge Kizkapan
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  4. Kadir Ilker Yildiz
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  5. Murat Onder
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  6. Mustafa Ozcamdalli
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Correspondence to Abdulhamit Misir.

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Conflict of Interest

Abdulhamit Misir, Erdal Uzun, Turan Bilge Kizkapan, Kadir Ilker Yildiz, Murat Onder and Mustafa Ozcamdalli declare that they have no conflict of interest.

Ethical Approval

This retrospective study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Clinical Investigations Research Ethics Committee (IRB) of Health Sciences University Metin Sabanci Baltalimani Bone and Joint Diseases Training and Research Hospital approved this study (Approval date and number 22.02.2018-24).

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Misir, A., Uzun, E., Kizkapan, T.B. et al. Reliability of RUST and Modified RUST Scores for the Evaluation of Union in Humeral Shaft Fractures Treated with Different Techniques. JOIO 54 (Suppl 1), 121–126 (2020). https://doi.org/10.1007/s43465-020-00182-8

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  • DOI: https://doi.org/10.1007/s43465-020-00182-8

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