The radiographic union scale in tibial (RUST) fractures

Abstract

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.

Correlation between RUST assessments of fracture healing to structural and biomechanical properties

“…However, these clinical parameters are subjective. The Radiographic Union Scale for Tibia fractures (RUST) was developed to aid in quantitatively evaluating fracture healing using radiographs …”

“…The standard RUST score is a radiographic assessment of fracture healing that has improved intra‐observer and inter‐observer reliability compared to other radiographic assessments . The RUST score provides an indication of the fracture healing on a continuous scale from 4 to 12 points.…”

“…The Radiographic Union Scale for Tibia fractures (RUST) was developed to aid in quantitatively evaluating fracture healing using radiographs. 4,5 The standard RUST score is a radiographic assessment of fracture healing that has improved intraobserver and inter-observer reliability compared to other radiographic assessments. [4][5][6][7][8] The RUST score provides an indication of the fracture healing on a continuous scale from 4 to 12 points.…”

“…4,5 The standard RUST score is a radiographic assessment of fracture healing that has improved intraobserver and inter-observer reliability compared to other radiographic assessments. [4][5][6][7][8] The RUST score provides an indication of the fracture healing on a continuous scale from 4 to 12 points. The score is determined by the presence of callus without visible fracture line (3 points), presence of callus with visible fracture line (2 points), or absence of any callus (1 point) on each of four cortices on anteroposterior (A-P) and lateral (Lat) radiographs.…”

The forgotten phase of fracture healing

“… 3 For clavicle fractures, symptoms and smoking status can indicate that a patient is at a greater risk of impaired healing, but does not identify individual nonunion. 4 Unfortunately, radiographs in adults (even when they are used in a standardised fashion) 5 and even CT scans, typically do not show evidence of fracture union for ten or more weeks. Thus assessing the rate of healing is especially difficult in the first two to three months post-fracture.…”