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

Chiavaras, Mary M.; Bains, Simrit; Choudur, Hema; Parasu, Naveen; Jacobson, Jon A.; Ayeni, Olufemi R.; Petrisor, Brad; Chakravertty, Rajesh; Sprague, Sheila; Bhandari, Mohit

doi:10.1007/s00256-013-1605-8

Cited by 74 publications

(50 citation statements)

References 28 publications

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“…Using this tool to grade the healing of femoral neck fractures leads to better agreement with respect to radiographic healing and improved intra-and interobserver reliability [5]. We sought to determine if this systematic and standardized scoring approach could be used to determine fracture healing and predict clinically important outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…The Radiographic Union Score for Hip (RUSH) is a previously validated tool that improves fracture healing agreement between radiologists and orthopaedic surgeons by using a checklist-based scoring approach [1,2,5]. Using this tool to grade the healing of femoral neck fractures leads to better agreement with respect to radiographic healing and improved intra-and interobserver reliability [5].…”

Section: Introductionmentioning

confidence: 99%

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The Radiographic Union Score for Hip (RUSH) Identifies Radiographic Nonunion of Femoral Neck Fractures

Frank

Osterhoff

Sprague

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background The Radiographic Union Score for Hip (RUSH) is a previously validated outcome instrument designed to improve intra-and interobserver reliability when describing the radiographic healing of femoral neck fractures. The ability to identify fractures that have not healed is important for defining nonunion in clinical trials and predicting patients who will likely require additional surgery to promote fracture healing. We sought to investigate the utility of the RUSH score to define femoral neck fracture nonunion. Questions/purposes (1) What RUSH score threshold yields at least 98% specificity to diagnose nonunion at 6 months postinjury? (2) Using the threshold identified, are patients below this threshold at greater risk of reoperation for nonunion and for other indications? Methods A representative sample of 250 out of a cohort of 725 patients with adequate 6-month hip radiographs was analyzed from a multinational elderly hip fracture trial (FAITH). All patients had a femoral neck fracture and were treated with either multiple cancellous screws or a sliding hip screw. Two reviewers independently determined the RUSH score based on the 6-month postinjury radiographs and interrater reliability was assessed with the interclass correlation coefficient (ICC). There was substantial reliability between the reviewers assigning the RUSH scores (ICC, 0.81; 95% confidence interval [CI], 0.76-0.85). The RUSH score is a checklist-based system that quantifies four measures of healing: cortical bridging, cortical fracture disappearance, trabecular consolidation, and trabecular fracture disappearance.. Fracture healing was determined by two independent methods: (1) concurrently by the treating surgeon using both clinical and radiographic assessments as per routine clinical care; and (2) retrospectively by a Central Adjudication Committee using complete obliteration of the fracture line on radiographs alone. Receiver operating characteristic tables were used to 123Clin Orthop Relat Res (2016) 474:1396-1404 DOI 10.1007 Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons® define a RUSH threshold score that was [ 98% specific for fracture nonunion. Results A threshold score of \ 18 was associated with a 100% specificity (95% CI, 97%-100%) and a positive predictive value of 100% (95% CI, 73%-100%) for radiographic nonunion. In contrast, using the fracture healing assessments of the treating surgeons failed to identify a useful discriminatory nonunion threshold and the highest positive predictive value was 43%. With respect to complications, patients with RUSH scores below 18 had greater risk of undergoing reoperation for nonunion ( Conclusions The 6-month RUSH score is a reliable method for assessing radiographic healing. Our results highlight the discordance between radiographic determinations and clinician assessments of fracture healing and stress the need for clinical data to be incorporated in research studies evaluating fracture healing. Level of Evidence Le...

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Radiographic Union Score for Hip (RUSH) Identifies Radiographic Nonunion of Femoral Neck Fractures

Frank

Osterhoff

Sprague

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…Recently introduced is a radiographic union scale for tibial fractures (RUST), as well as the radiographic union scale for hip (RUSH), both of which have been shown to increase agreement in inter-observer reliability among both surgeons and radiologists [35][36][37][38]. RUST is based on callus formation on the anterior, posterior, medial, and lateral cortices seen on AP and lateral radiographs of the fracture.…”

Section: Radiographic Evaluationmentioning

confidence: 99%

Clinical Aspects of Fracture Healing: An Overview

Liu

Buza

Leucht

2015

Clinic Rev Bone Miner Metab

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The assessment, diagnosis, and management of fractures, particularly fractures that exhibit delayed healing, present considerable unique challenges to both patients and physicians. Fracture healing results from a complex series of biochemical events that may produce complete restoration of the anatomic and biochemical properties of the original osseous tissue. Fracture healing requires appropriate reduction, mechanical stability, and adequate vascularity to the fracture site; compromise of one of these elements may lead to delayed healing or nonunion. The patient's history, physical examination, and findings based on radiographs or other imaging modalities allow for assessment and characterization of the progression of healing. If nonunion is recognized, it is important for the clinician to understand the current treatment options that are available to optimize healing. Physical stimulation therapies include electromagnetic stimulation and low-intensity pulsed ultrasonography. Osteogenic factors used locally to promote fracture healing include autologous bone marrow and peptide signaling molecules such as platelet-derived growth factors, fibroblast growth factors, and bone morphogenetic proteins. Systemic biological protein such as parathyroid hormone and factors that target the Wnt family of signaling molecules offers promising data regarding its abilities to promote healing. Large segmental defects must be managed depending on the type and severity of the injury and may require treatment with bone grafts, induced membrane techniques, acute shortening, or distraction osteogenesis. A systematic approach in evaluating fracture union and an understanding of the modern methods to promote fracture healing will allow clinicians to significantly improve the treatment of patients with these injuries.

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“…In the evaluation of the X-rays, qualifications such as whether callus formation is visible and whether the fracture line is visible help to quantify the degree of fracture healing that has occurred at the fracture site. Scoring systems such as the radiographic union score for hip (RUSH) [50,51] and radiographic union score for tibia (RUST) [52] are based on cortical scores. It is from these scoring systems that the concept that only two cortices could be completely radiographically healed (and get a healed level score) and yet the other two cortices could still show fracture lines and some or no callus.…”

Section: Trial Designmentioning

confidence: 99%

Fracture healing: a consensus report from the International Osteoporosis Foundation Fracture Working Group

Silverman

Kupperman²,

Bukata³

2016

Osteoporos Int

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

Cited by 74 publications

References 28 publications

The Radiographic Union Score for Hip (RUSH) Identifies Radiographic Nonunion of Femoral Neck Fractures

The Radiographic Union Score for Hip (RUSH) Identifies Radiographic Nonunion of Femoral Neck Fractures

Clinical Aspects of Fracture Healing: An Overview

Fracture healing: a consensus report from the International Osteoporosis Foundation Fracture Working Group

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