Evaluation of fracture stability: A mechanical simulator for assessment of clinical judgement

Hammer, Richard; Norrbom, Henry

doi:10.3109/17453678408992367

Cited by 19 publications

(11 citation statements)

References 9 publications

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“…Webb et al showed that manual assessment of stiffness by orthopaedic surgeons was not superior to that of medical students [ 96 ]. Additionally, it was shown that physicians, regardless of number of years of experience, are not reliable in judging stability with increasing stiffness of fractures [ 97 ]. As discussed above, other more reliable biomechanical modalities of assessment of stiffness are not currently used as clinical tools.…”

Section: Clinical Assessment Of Healingmentioning

confidence: 99%

Current Options for Determining Fracture Union

Morshed

2014

Advances in Medicine

161

107

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Determining whether a bone fracture is healed is one of the most important and fundamental clinical determinations made in orthopaedics. However, there are currently no standardized methods of assessing fracture union, which in turn has created significant disagreement among orthopaedic surgeons in both clinical and research settings. An extensive amount of research has been dedicated to finding novel and reliable ways of determining healing with some promising results. Recent advancements in imaging techniques and introduction of new radiographic scores have helped decrease the amount of disagreement on this topic among physicians. The knowledge gained from biomechanical studies of bone healing has helped us refine our tools and create more efficient and practical research instruments. Additionally, a deeper understanding of the molecular pathways involved in the bone healing process has led to emergence of serologic markers as possible candidates in assessment of fracture union. In addition to our current physician centered methods, patient-centered approaches assessing quality of life and function are gaining popularity in assessment of fracture union. Despite these advances, assessment of union remains an imperfect practice in the clinical setting. Therefore, clinicians need to draw on multiple modalities that directly and indirectly measure or correlate with bone healing when counseling patients.

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Section: Clinical Assessment Of Healingmentioning

confidence: 99%

Current Options for Determining Fracture Union

Morshed

2014

Advances in Medicine

161

107

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“…Additionally, it has been shown that physicians, regardless of number of years of experience, are not consistent when assessing the increasing stiffness of fractures with time. 12 Pain on palpation at the site of injury is also currently widely used among physicians to judge union, however, it is a highly subjective outcome given individual and cultural differences in perception and tolerance level of pain among the patient population. In addition, the assessment of a fracture with a reamed nail (which provides stability to allow early weight bearing) results in difficulty in the clinical assessment of fracture union.…”

Section: Discussionmentioning

confidence: 99%

The radiographic union scale in tibial (RUST) fractures

Leow

Clement

Tawonsawatruk

et al. 2016

Bone & Joint Research

123

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ObjectivesThe radiographic union score for tibial (RUST) fractures was developed by Whelan et al to assess the healing of tibial fractures following intramedullary nailing. In the current study, the repeatability and reliability of the RUST score was evaluated in an independent centre (a) using the original description, (b) after further interpretation of the description of the score, and (c) with the immediate post-operative radiograph available for comparison.MethodsA total of 15 radiographs of tibial shaft fractures treated by intramedullary nailing (IM) were scored by three observers using the RUST system. Following discussion on how the criteria of the RUST system should be implemented, 45 sets (i.e. AP and lateral) of radiographs of IM nailed tibial fractures were scored by five observers. Finally, these 45 sets of radiographs were rescored with the baseline post-operative radiograph available for comparison.ResultsThe initial intraclass correlation (ICC) on the first 15 sets of radiographs was 0.67 (95% CI 0.63 to 0.71). However, the original description was being interpreted in different ways. After agreeing on the interpretation, the ICC on the second cohort improved to 0.75. The ICC improved even further to 0.79, when the baseline post-operative radiographs were available for comparison.ConclusionThis study demonstrates that the RUST scoring system is a reliable and repeatable outcome measure for assessing tibial fracture healing. Further improvement in the reliability of the scoring system can be obtained if the radiographs are compared with the baseline post-operative radiographs.Cite this article: Mr J.M. Leow. The radiographic union scale in tibial (RUST) fractures: Reliability of the outcome measure at an independent centre. Bone Joint Res 2016;5:116–121. DOI: 10.1302/2046-3758.54.2000628.

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“…Unfortunately, it is not a quantifiable nor reproducible measure of outcome. Assessments of Xray radiographs have been shown to lead to erroneous conclusions by several authors, notably Nicholls et al 2 and McClelland et al 3 Hammer and Norrbom 4 and Webb et al, 5 among others, demonstrated that subjective fracture manipulation is a weak assessment method. Hence, neither method of assessment has a place in a research protocol.…”

Section: Introductionmentioning

confidence: 99%

A practical, quantitative, fracture healing endpoint assessment criterion for tibial fractures treated with external fixation

Ogrodnik

Thomas

2019

Proc Inst Mech Eng H

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There is a need for a quick, simple, repeatable, but quantifiable assessment tool to determine the fracture healing endpoint of tibial fractures that does not rely on the use of X-rays or on un-measured manipulation. This article presents an argument to support a ‘maximum of 1° bending’ criterion. The criterion was established from an examination of patient fracture stiffness profiles and following observations of stiffness measurements made in clinics. A proprietary mono-lateral external fixator was used to test the criterion. Sixty subjects had their fracture healing endpoint assessed using this criterion compared with the 15 N m/deg in two planes criterion, and it was deemed to be successful. The method of assessment for both mono-lateral and frame fixation (Ilizarov) is demonstrated.

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Evaluation of fracture stability: A mechanical simulator for assessment of clinical judgement

Cited by 19 publications

References 9 publications

Current Options for Determining Fracture Union

Current Options for Determining Fracture Union

The radiographic union scale in tibial (RUST) fractures

A practical, quantitative, fracture healing endpoint assessment criterion for tibial fractures treated with external fixation

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