Hughes Meghan, Brand Jordan, Edmond Tyler, Zhang Tina, Raffetto Michael, Turner Kristin E, Lawrence Joshua E, Kovvur Murali, Gage Mark J, Nascone Jason W, Sciadini Marcus F, O'Hara Nathan N, O'Toole Robert V
R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
Injury. 2025 Aug;56(8):112512. doi: 10.1016/j.injury.2025.112512. Epub 2025 Jun 3.
To determine if 4-8-week radiographs are useful for predicting nonunions in patients with femoral shaft fractures treated with an intramedullary nail (IMN).
A retrospective case-control study; 1:2 ratio was conducted at a level I trauma center. Adult patients with a femoral shaft fracture (OTA/AO 32) treated with IMN between 2016 and 2022 were identified via Current Procedural Terminology code. The included cases underwent nonunion surgery a minimum of 3 months after the index procedure. The controls were randomly selected from the cohort and had a minimum of 6 months postoperative follow-up and evidence of radiographic union. The modified Radiographic Union Score of the Tibia (mRUST) applied to femur fractures was determined on radiographs obtained 4-8 weeks after the index surgery.
One hundred forty-eight patients (mean age, 35 [SD, 15] years) were included. A significant difference was found between cases and controls relating to the distribution of mRUST scores at 4-8 weeks postoperatively (median, 6 versus 9; p < 0.0001). Logistic regression analysis demonstrated that the mRUST score at 4-8 weeks is a strong predictor of union with an area under the curve of 0.85 (95 % CI: 0.78-0.92). If the mRUST score at 4-8 weeks postoperatively is 9 or above, the probability of eventual union is 99 % (95 % CI: 94-100 %).
The results suggest that healing on 4-8-week radiographs after IMN fixation for femoral shaft fractures may help identify patients at elevated risk of nonunion. Patients with mRUST scores 9 or above on the 4-8-week postoperative radiographs have a low likelihood of nonunion and less frequent radiographic follow-up may be needed.
确定4 - 8周时的X线片是否有助于预测采用髓内钉（IMN）治疗的股骨干骨折患者发生骨不连的情况。
在一级创伤中心进行一项回顾性病例对照研究，病例与对照比例为1:2。通过当前操作术语代码识别2016年至2022年间接受IMN治疗的股骨干骨折（OTA/AO 32）成年患者。纳入的病例在初次手术后至少3个月接受了骨不连手术。对照组从队列中随机选取，术后至少随访了6个月且有影像学骨愈合的证据。在初次手术后4 - 8周获得的X线片上确定应用于股骨骨折的改良胫骨影像学骨愈合评分（mRUST）。
共纳入148例患者（平均年龄35[标准差15]岁）。病例组与对照组在术后4 - 8周时mRUST评分分布上存在显著差异（中位数分别为6和9；p < 0.0001）。逻辑回归分析表明，术后4 - 8周时mRUST评分是骨愈合的有力预测指标，曲线下面积为0.85（95%CI：0.78 - 0.92）。如果术后4 - 8周时mRUST评分达到9或更高，最终骨愈合的概率为99%（95%CI：94 - 100%）。
结果表明，股骨干骨折IMN固定后4 - 8周X线片上的愈合情况可能有助于识别骨不连风险较高的患者。术后4 - 8周X线片上mRUST评分达到9或更高的患者发生骨不连的可能性较低，可能需要较少次数的影像学随访。
