Skeletal Radiology

, Volume 42, Issue 8, pp 1079–1088 | Cite as

The Radiographic Union Score for Hip (RUSH): the use of a checklist to evaluate hip fracture healing improves agreement between radiologists and orthopedic surgeons

  • Mary M. ChiavarasEmail author
  • Simrit Bains
  • Hema Choudur
  • Naveen Parasu
  • Jon Jacobson
  • Olufemi Ayeni
  • Brad Petrisor
  • Rajesh Chakravertty
  • Sheila Sprague
  • Mohit Bhandari
Scientific Article



The assessment of fracture healing following intertrochanteric fracture fixation is highly variable with no validated standards. Agreement with respect to fracture healing following surgery is important for optimal patient management. The purpose of this study was to (1) assess reliability of intertrochanteric fracture healing assessment and (2) determine if a novel radiographic scoring system for hip fractures improves agreement between radiologists and orthopedic surgeons.

Materials and methods

A panel of three radiologists and three orthopedic surgeons assessed fracture healing in 150 cases of intertrochanteric fractures at two separate time points to determine inter-rater and intra-rater agreement. Reviewers, blinded to the time after injury, first subjectively assessed overall healing using frontal and lateral radiographs for each patient at a single time point. Reviewers then scored each fracture using a Radiographic Union Score for Hip (RUSH) form to determine whether this improves agreement regarding hip fracture healing.


Inter-rater agreement for the overall subjective impression of fracture healing between reviewer groups was only fair (intraclass coefficient [ICC] = 0.34, 95 % CI: 0.11–0.52. Use of the RUSH score improved overall agreement between groups to substantial (ICC = 0.66, 95 % CI: 0.53–0.75). Across reviewers, healing of the medial cortex and overall RUSH score itself demonstrated high correlations with overall perceptions of healing (r = 0.53 and r = 0.72, respectively).


The RUSH score improves agreement of fracture healing assessment between orthopedic surgeons and radiologists, offers a systematic approach to evaluating intertrochanteric hip fracture radiographs, and may ultimately provide prognostic information that could predict healing outcomes in patients with femoral neck fractures.


Hip fractures Intertrochanteric fractures Fracture healing Reliability Radiographs 


Conflict of interest

The authors declare that they have no conflict of interest.

Financial support

Funding for this research was provided a research grant from AMGEN Inc. and Dr. Bhandari was funded, in part, by a Canada Research Chair.


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Copyright information

© ISS 2013

Authors and Affiliations

  • Mary M. Chiavaras
    • 1
    • 6
    Email author
  • Simrit Bains
    • 2
  • Hema Choudur
    • 1
  • Naveen Parasu
    • 1
  • Jon Jacobson
    • 3
  • Olufemi Ayeni
    • 4
  • Brad Petrisor
    • 4
  • Rajesh Chakravertty
    • 5
  • Sheila Sprague
    • 4
  • Mohit Bhandari
    • 4
  1. 1.Department of RadiologyMcMaster UniversityHamiltonCanada
  2. 2.University of Western Ontario Medical SchoolLondonCanada
  3. 3.Department of RadiologyUniversity of MichiganAnn ArborUSA
  4. 4.Department of Orthopedic SurgeryMcMaster UniversityHamiltonCanada
  5. 5.Department of Orthopedic SurgeryUniversity of TorontoTorontoCanada
  6. 6.Department of Diagnostic ImagingHamilton General HospitalHamiltonCanada

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