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Saturday, March 3, 2001

Newly-developed healing scale provides reliable

Following intramedullary nailing of tibial shaft fractures, fracture healing is routinely based upon clinical and radiographic assessments. The purpose of a study in poster exhibit 91 was to evaluate the reliability of a newly developed scale to assess radiographic union in healing tibial shaft fractures treated with intramedullary nails.

The investigators concluded that the radiographic union assessment scale exhibits substantial improvements in reliability from previously published scales. Moreover, it produces equally reproducible results among orthopaedic residents, community orthopaedic surgeons, and orthopaedic traumatologists.

Forty-five sets of AP and lateral radiographs of tibial shaft fractures treated with intramedullary fixation were selected from a trauma database to represent fractures at different stages of healing. Seven reviewers (two orthopaedic residents, two community orthopaedic surgeons, and three orthopaedic traumatologists) independently scored the stage of fracture healing from a minimum score of 4 to a maximum score of 12 (Radiographic Union Scale for Tibial Fractures-R.U.S.T).

The scale is based upon quality of the bridging callus on four cortices from AP and lateral radiographs. The radiographs were reassessed at eight weeks for interobserver reproducibility. Reviewers were blinded to all aspects of patient history and clinical examination. Intraclass correlation coefficients (ICC) with 95 percent confidence intervals were used to measure agreement. Overall agreement among all reviewers collectively was substantial: ICC=0.86 (95 percent CI, 0.79-0.91). Additionally, there was trend towards improved reliability among traumatologists when compared to either community surgeons or residents (ICC=0.86, 0.83, and 0.81, respectively). Overall, intraobserver reliability for the scale was also substantial (ICC=0.88, 95%, CI, 0.80-0.96).

The coauthors of the study said use of this simple and reliable scale to assess fracture healing has important implications in standardizing outcomes in trauma. The investigators are Daniel B. Whelan MD, St. Michael's Hospital, Toronto, Ont.; Mohit Bhandari MD, Toronto, Ont.; Mark Shekhman Toronto, Ont.; Michael D. McKee MD, Toronto, Ont.; Hans J. Kreder MD, University of Toronto Sunnybrook Health Science Center, Toronto, Ont.; David J.G. Stephen MD, Sunnybrook and Women's College Health Science Center, Toronto, Ont.; and Emil H. Schemitsch MD, St. Michael's Hospital, Toronto, Ont.

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2001 Academy News March 3 Index B

Last modified 20/February/2001 by IS