Department of Orthopedics and Traumatology, Sarkışla State Hospital, 58400 Şarkışla, Sivas, Turkey.
Jt Dis Relat Surg. 2021;32(1):185-191. doi: 10.5606/ehc.2021.78465. Epub 2021 Jan 6.
This study aims to evaluate the reliability of the radiographic union scale in tibial (RUST) fractures and modified RUST (mRUST) fractures in pediatric forearm fractures treated with elastic stable intramedullary nail (ESIN) and to investigate the effect of the experience of surgeon, thresholds for union, and delayed union decisions.
In this retrospective study, radiographic images of 20 patients (10 males, 10 females; mean age 8.6±4.3; range, 4 to 11 years) with forearm fractures treated using ESIN between January 2013 and December 2018 were scored by 20 observers based on the RUST and mRUST scores. The observers scored the radiographs at immediate postoperative period, and at 4-, 8-, and 12-week follow-up. Intra- and interobserver agreement for each cortex, RUST, and mRUST were evaluated using intraclass correlation coefficient (ICC). The Fleiss' kappa (κ) coefficient was used in the agreement between evaluators regarding union decision. Receiver operating curves were created to determine the thresholds for radiographic union and delayed union.
Intra- and interobserver reliability of the mRUST score (ICC: 0.84 and 0.79) were slightly higher than that of the RUST score (ICC: 0.80 and 0.72). Pediatric orthopedic and trauma surgeons had slightly higher agreement than the residents and general orthopedists for the total mRUST and RUST scores of the eight-week radiographs. Mean RUST and mRUST scores at the union for all fractures were 10.2±3.4 and 13.0±2.1, respectively. Kappa value for union was moderate (0.74). The total mRUST score had a higher predictive value for union than the total RUST score (area under the curve: 0.986 vs. 0.889). A mRUST score of ≥12 and RUST score of ≥9 were considered as the predictors of union. In addition, a mRUST score of ≤7 and RUST score of <9 were considered as the predictors of delayed union.
A moderate agreement for both RUST and mRUST scores was found. However, the agreement for mRUST was found to be slightly higher. Healing and union of forearm fractures treated with ESIN can be reliably assessed using RUST and mRUST.
本研究旨在评估 RUST 评分（桡骨）和改良 RUST（mRUST）评分在儿童前臂骨折中治疗弹性稳定髓内钉（ESIN）的可靠性，并探讨术者经验、愈合标准和延迟愈合决策的影响。
在这项回顾性研究中，对 2013 年 1 月至 2018 年 12 月期间采用 ESIN 治疗的 20 例前臂骨折患者（10 名男性，10 名女性；平均年龄 8.6±4.3 岁；范围 4 至 11 岁）的影像学图像进行评分，由 20 名观察者根据 RUST 和 mRUST 评分进行评分。观察者在术后即刻、4 周、8 周和 12 周进行放射影像学评分。采用组内相关系数（ICC）评估每个皮质、RUST 和 mRUST 的观察者内和观察者间一致性。采用 Fleiss'κ系数评估观察者间对愈合判断的一致性。绘制受试者工作特征曲线以确定影像学愈合和延迟愈合的标准。
mRUST 评分的观察者内和观察者间可靠性（ICC：0.84 和 0.79）略高于 RUST 评分（ICC：0.80 和 0.72）。与住院医师和普通骨科医生相比，小儿矫形和创伤外科医生对 8 周时的 mRUST 和 RUST 总评分的一致性更高。所有骨折愈合时的平均 RUST 和 mRUST 评分为 10.2±3.4 和 13.0±2.1。所有骨折的愈合判断的κ值为中度（0.74）。mRUST 总评分对愈合的预测价值高于 RUST 总评分（曲线下面积：0.986 比 0.889）。mRUST 评分≥12 和 RUST 评分≥9 被认为是愈合的预测因素。此外，mRUST 评分≤7 和 RUST 评分<9 被认为是延迟愈合的预测因素。
RUST 和 mRUST 评分的一致性中等，但 mRUST 评分的一致性略高。采用 RUST 和 mRUST 评分可可靠评估采用 ESIN 治疗的前臂骨折的愈合和愈合情况。
