TY - JOUR
T1 - Inter-Rater Reliability of the Modified Radiographic Union Score for Diaphyseal Tibial Fractures with Bone Defects
AU - Mitchell, Stuart L.
AU - Obremskey, William T.
AU - Luly, Jason
AU - Bosse, Michael J.
AU - Frey, Katherine P.
AU - Hsu, Joseph R.
AU - MacKenzie, Ellen J.
AU - Morshed, Saam
AU - O'Toole, Robert V.
AU - Scharfstein, Daniel O.
AU - Tornetta, Paul
N1 - Publisher Copyright:
© 2019 Lippincott Williams and Wilkins. All rights reserved.
PY - 2019/6/1
Y1 - 2019/6/1
N2 - Objectives:To evaluate inter-rater reliability of the modified Radiographic Union Score for Tibial (mRUST) fractures among patients with open, diaphyseal tibia fractures with a bone defect treated with intramedullary nails (IMNs), plates, or definitive external fixation (ex-fix).Design:Retrospective cohort study.Setting:Fifteen-level one civilian trauma centers; 2 military treatment facilities.Patients/Participants:Patients ≥18 years old with open, diaphyseal tibia fractures with a bone defect ≥1 cm surgically treated between 2007 and 2012.Intervention:Three of 6 orthopedic traumatologists reviewed and applied mRUST scoring criteria to radiographs from the last clinical visit within 13 months of injury.Main Outcome Measurements:Inter-rater reliability was assessed using Krippendorff's alpha (KA) statistic; intraclass correlation coefficient (ICC) is presented for comparison with previous publications.Results:Two hundred thirteen patients met inclusion criteria including 115 IMNs, 24 plates, 29 ex-fixes, and 45 cases that no longer had instrumentation at evaluation. All reviewers agreed on the pattern of scoreable cortices for 90.4% of IMNs, 88.9% of those without instrumentation, 44.8% of rings, and 20.8% of plates. Thirty-one (15%) cases, primarily plates and ex-fixes, did not contribute to KA and ICC estimates because <2 raters scored all cortices. The overall KA for the 85% that could be analyzed was 0.64 (ICC 0.71). For IMNs, plates, ex-fixes, and no instrumentation, KA (ICC) was 0.65 (0.75), 0.88 (0.90), 0.47 (0.62), and 0.48 (0.57), respectively.Conclusions:In tibia fractures with bone defects, the mRUST seems similarly reliable to previous work in patients treated with IMN but is less reliable in those with plates or ex-fixes, or after removal of instrumentation.
AB - Objectives:To evaluate inter-rater reliability of the modified Radiographic Union Score for Tibial (mRUST) fractures among patients with open, diaphyseal tibia fractures with a bone defect treated with intramedullary nails (IMNs), plates, or definitive external fixation (ex-fix).Design:Retrospective cohort study.Setting:Fifteen-level one civilian trauma centers; 2 military treatment facilities.Patients/Participants:Patients ≥18 years old with open, diaphyseal tibia fractures with a bone defect ≥1 cm surgically treated between 2007 and 2012.Intervention:Three of 6 orthopedic traumatologists reviewed and applied mRUST scoring criteria to radiographs from the last clinical visit within 13 months of injury.Main Outcome Measurements:Inter-rater reliability was assessed using Krippendorff's alpha (KA) statistic; intraclass correlation coefficient (ICC) is presented for comparison with previous publications.Results:Two hundred thirteen patients met inclusion criteria including 115 IMNs, 24 plates, 29 ex-fixes, and 45 cases that no longer had instrumentation at evaluation. All reviewers agreed on the pattern of scoreable cortices for 90.4% of IMNs, 88.9% of those without instrumentation, 44.8% of rings, and 20.8% of plates. Thirty-one (15%) cases, primarily plates and ex-fixes, did not contribute to KA and ICC estimates because <2 raters scored all cortices. The overall KA for the 85% that could be analyzed was 0.64 (ICC 0.71). For IMNs, plates, ex-fixes, and no instrumentation, KA (ICC) was 0.65 (0.75), 0.88 (0.90), 0.47 (0.62), and 0.48 (0.57), respectively.Conclusions:In tibia fractures with bone defects, the mRUST seems similarly reliable to previous work in patients treated with IMN but is less reliable in those with plates or ex-fixes, or after removal of instrumentation.
KW - bone defect
KW - fracture healing
KW - inter-rater reliability
KW - mRUST score
KW - radiographic union
KW - tibia fracture
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U2 - 10.1097/BOT.0000000000001445
DO - 10.1097/BOT.0000000000001445
M3 - Article
C2 - 30741726
AN - SCOPUS:85066919331
SN - 0890-5339
VL - 33
SP - 301
EP - 307
JO - Journal of orthopaedic trauma
JF - Journal of orthopaedic trauma
IS - 6
ER -