Guevel Borna, Gokaraju Kishan, Mohamed Foad, Sorensen Frederik, Gillott Elizabeth, Domos Peter
Royal Free London NHS Foundation Trust, Barnet and Chase Farm Hospitals, London, UK.
Shoulder Elbow. 2022 Jun;14(3):295-303. doi: 10.1177/17585732211033154. Epub 2021 Jul 27.
Non-union in non-operatively managed humeral shaft fractures are associated with significant morbidity. Hence, developing a robust system that could help with early diagnosis is important. We aimed to evaluate the validity of the Radiographic Union Score for HUmeral fractures (RUSHU) at 6 weeks (RUSHU-6) and test whether a RUSHU at 12 weeks (RUSHU-12) would be a better predictor of non-union.
We retrospectively reviewed all non-operatively managed humeral diaphyseal fractures from 2012 to 2018. Statistical analysis was used to determine the cut-off RUSHU-12 and evaluate the effect of RUSHU-6 and RUSHU-12 on non-union prediction.
In sum, 32 patients had radiographs at 6 weeks post-injury, 27 of which also had radiographs at 12 weeks. A RUSHU cut-off of 9 was the best predictor of non-union at 12 weeks. Only RUSHU-12 had a statistically significant influence predicting non-union (P = 0.011) and there was a significant correlation (P = 0.003) between score progression from RUSHU-6 to RUSHU-12 and the development of non-union.
A RUSHU-12 of <9 and a low score progression between 6 and 12 weeks suggest superior predictive value in determining the likelihood of non-union. Further validation in the form of a large multicentred study is however required.
非手术治疗的肱骨干骨折不愈合会导致严重的发病率。因此，开发一个有助于早期诊断的强大系统很重要。我们旨在评估6周时肱骨骨折影像学愈合评分（RUSHU-6）的有效性，并测试12周时的RUSHU（RUSHU-12）是否能更好地预测骨折不愈合。
我们回顾性分析了2012年至2018年所有非手术治疗的肱骨干骨折病例。采用统计学分析确定RUSHU-12的临界值，并评估RUSHU-6和RUSHU-12对骨折不愈合预测的效果。
总共有32例患者在受伤后6周进行了X线检查，其中27例在12周时也进行了X线检查。RUSHU临界值为9是12周时骨折不愈合的最佳预测指标。只有RUSHU-12对骨折不愈合的预测有统计学意义（P = 0.011），并且从RUSHU-6到RUSHU-12的评分进展与骨折不愈合的发生之间存在显著相关性（P = 0.003）。
RUSHU-12<9且6至12周之间评分进展较低表明在确定骨折不愈合可能性方面具有较高的预测价值。然而，需要通过大型多中心研究进行进一步验证。
