Dominik Deppe, Matteo Gabriele, Manuel Giovanni Mazzoleni, Alejandro Ordas-Bayon, Andrea Fidanza, Yuriy Rozhko, Ekin Kaya Şimşek, Eran Keltz, Georg Osterhoff, Philipp Damm, Georg N Duda, Marko Leskovar, Stefan Zachow, Adam Trepczynski, Mark Heyland
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引用次数: 0
Abstract
Objectives: To evaluate the reliability of the modified Radiographic Union Score for Tibial fractures (mRUST) as a reliable tool for monitoring lower limb fractures (Femur, Tibia) treated with various modalities (Nail, Plate).
Methods: Design: Retrospective analysis.
Setting: Single center academic hospital in Germany.
Patient selection criteria: Adult patients (≥18 years) with extra-articular long bone fractures of the lower extremities treated surgically between January 2005 and April 2022, requiring radiographs in two perpendicular planes and at least one follow-up visit, were included. Exclusion criteria were critical clinical conditions, inability to consent, joint articulation fractures, inadequate documentation, or insufficient imaging quality.
Outcome measures and comparisons: Six international investigators (five orthopedic surgeons, one radiologist) independently assessed fracture line and callus growth per cortex (mRUST) at individualized follow-up timepoints based on clinical practice. To evaluate inter-rater reliability, intraclass correlation coefficients (ICC) were calculated for the overall dataset, and for subsets of rated images, that were defined based on anatomical location (femur/tibia), treatment type (plate/nail fixation), and treatment combinations across locations.
Results: A total of 166 patients (63 femur fractures, 103 tibia fractures; 32.5% female, mean age 43.4 (18-84)) with 1,136 follow-up timepoints were analyzed. Overall inter-rater reliability for mRUST was good (ICC 0.77), consistent across fixation methods (nail/plate fixation, 0.79) and anatomical locations (tibia, 0.78; femur, 0.81). Cortex-specific reliability varied, with highest agreement for the medial cortex (0.70-0.74) and lowest for the posterior cortex (0.65-0.74).
Conclusions: The mRUST (radiographic score) demonstrated reliability for monitoring fracture healing in the femur and tibia, irrespective of fixation method, supporting its use as a generalizable tool across lower limb fractures.
期刊介绍：
Journal of Orthopaedic Trauma is devoted exclusively to the diagnosis and management of hard and soft tissue trauma, including injuries to bone, muscle, ligament, and tendons, as well as spinal cord injuries. Under the guidance of a distinguished international board of editors, the journal provides the most current information on diagnostic techniques, new and improved surgical instruments and procedures, surgical implants and prosthetic devices, bioplastics and biometals; and physical therapy and rehabilitation.
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