Reliability of modified Radiographic Union Scale for Tibial Fractures (mRUST) Scores in Ballistic Lower Extremity Trauma.

IF 2 3区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Trauma Pub Date : 2026-06-22 DOI:10.1097/BOT.0000000000003236

Patrick Sun, Jennifer Eurich, Douglas Zhang, Gregory Schimizzi, Anthony Christiano, Mary Kate Erdman

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引用次数: 0

Abstract

Objectives: To investigate the reliability of the modified Radiographic Union Scale for Tibial Fractures (mRUST) scores in ballistic lower extremity trauma and to assess the ability of 3-month post-op mRUST in predicting union status at 9-months.

Methods: Design: Retrospective review.

Setting: Single Level 1 Trauma Center.

Patient selection criteria: Patients that sustained a ballistic femoral (AO/OTA 32) or tibial shaft fracture (AO/OTA 42) aged 18 or over and were treated with intramedullary nailing between 2019 and 2023.

Outcome measures and comparisons: Inter- and intra-rater reliability of mRUST score measurements between three fellowship trained orthopaedic trauma surgeons was assessed. The sensitivity and specificity of predicting nonunion at 9-months postoperatively from mRUST 3-months postoperatively was assessed. Inclusion criteria for nonunion analysis required patients to have a 3-month mRUST score as well as a determinable union status.

Results: 107 ballistic femoral shaft fractures (203 radiograph sets; 100 male; mean age 31 [18-56]) and 62 ballistic tibial shaft fractures (153 radiograph sets; 51 male; mean age 33 [18-61]) were used to calculate reliability metrics. Inter-rater reliability (Intraclass Correlation Coefficient, ICC) of mRUST in ballistic femoral shaft fractures was 0.64 (95% CI[0.34,0.80]). Intra-rater reliability of mRUST in ballistic femoral shaft fractures was 0.87 (95% CI[0.85,0.89]). Inter-rater reliability of mRUST in ballistic tibial shaft fractures was 0.61 (95% CI[0.43,0.73]) and intra-rater reliability of mRUST in ballistic tibial shaft fractures was 0.81 (95% CI[0.77, 0.84]). In 28 ballistic femoral shaft fractures (24 male; mean age 31 [18-46]), an mRUST-3MO < 8 predicted nonunion in ballistic femoral shaft fractures with a sensitivity of 1.00 and specificity of 0.83. In 25 ballistic tibial shaft fractures (17 males; mean age 34 [18-61]), an mRUST-3MO < 8 predicted nonunion with a sensitivity of 0.71 and specificity of 0.94.

Conclusions: This study suggests that the modified Radiographic Union Scale for Tibial Fractures (mRUST) scores possess a lower inter and intra rater reliability in ballistic fractures compared to blunt fractures. They may predict union at 9-months well in ballistic femoral fractures, but only moderately in ballistic tibia fractures.

Level of evidence: Diagnostic Level III.

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改良胫骨骨折放射联合评分（mRUST）在弹道性下肢创伤中的可靠性。

目的：探讨改良胫骨骨折放射愈合量表（mRUST）在弹道性下肢创伤中的可靠性，并评估术后3个月mRUST预测9个月愈合状况的能力。方法：设计：回顾性分析。环境：单一的一级创伤中心。患者选择标准：2019年至2023年期间，18岁及以上的股骨弹道骨折（AO/OTA 32）或胫骨骨干骨折（AO/OTA 42）并接受髓内钉治疗的患者。结果测量和比较：评估了三位接受过奖学金培训的骨科创伤外科医生之间mRUST评分测量的内部和内部可靠性。评估mRUST术后3个月预测术后9个月骨不连的敏感性和特异性。骨不连分析的纳入标准要求患者有3个月的mRUST评分以及确定的骨不连状态。结果：107例弹道性股骨干骨折（203组x线片，100例男性，平均年龄31[18-56]）和62例弹道性胫骨骨干骨折（153组x线片，51例男性，平均年龄33[18-61]）用于计算可靠性指标。mRUST在弹道型股骨干骨折中的组内相关系数（Intraclass Correlation Coefficient， ICC）为0.64 （95% CI[0.34,0.80]）。mRUST治疗弹道型股骨干骨折的可靠性为0.87 （95% CI[0.85,0.89]）。mRUST在弹道胫骨干骨折中的可靠性为0.61 (95% CI[0.43,0.73])， mRUST在弹道胫骨干骨折中的可靠性为0.81 （95% CI[0.77, 0.84]）。在28例弹道性股骨干骨折中（24例男性，平均年龄31岁[18-46]），mRUST-3MO < 8预测弹道性股骨干骨折不愈合的敏感性为1.00，特异性为0.83。在25例弹道胫骨干骨折（17例男性，平均年龄34岁[18-61]）中，mRUST-3MO < 8预测骨不连的敏感性为0.71，特异性为0.94。结论：本研究表明，与钝性骨折相比，改良的胫骨骨折放射愈合量表（mRUST）评分在弹道骨折中具有较低的内部可靠性。它们可以很好地预测9个月时弹道股骨骨折的愈合，但在弹道胫骨骨折中仅能中等程度地预测愈合。证据等级：诊断级III。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Orthopaedic Trauma 医学-运动科学

CiteScore

3.90

自引率

8.70%

发文量

396

审稿时长

3-8 weeks

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.