PURPOSE OF THE STUDY The aim of our study is to investigate the reliabilities of the radiographic union score for tibial fracture (RUST) and modified RUST scoring systems in the evaluation of fracture healing in adult tibia fractures treated with intramedullary nailing and pediatric tibia fractures treated with closed reduction and cast immobilization and to compare the reliabilities between two groups. MATERIAL AND METHODS Between January 2016 and January 2020, the informations of patients (ages of 4-10) with tibia fractures treated with closed reduction and casting and patients (aged 18-65 years) with tibia fractures treated with intramedullary nailing were analyzed retrospectively. Forty-seven good quality AP and lateral radiographs (represent different healing stages) each for pediatric and adult fracture groups were selected and were included in two PPTs separately. The radiographs were assessed twice with an interval of three weeks by an observer group consisting of four senior orthopedic surgeons and four orthopedic residents, and fractures were evaluated according to the RUST and mRUST scoring systems. RESULTS The inter-observer agreement of RUST and mRUST were 'perfect' in adult tibia fractures and 'substantial' in pediatric tibia fractures in both evaluations. However, in deciding fracture consolidation, inter-observer agreement was found to be 'perfect' in pediatric tibia fractures, while it was 'substantial' in adult fractures in both assessments. The mean intra-observer reliability of RUST system in adult tibia fractures was 0.860 (0.674-0.968) and 0.818 (0.693-0.909) in pediatric tibia fractures, respectively. The mean intra-observer agreement of mRUST system was 0.842(0.745-0.979) in adult fractures and 0.857 (0.756-0.932) in pediatric fractures, respectively. The mean intra-observer reliability of decision on union was 0.842 (0.638-1.000) in adult fractures and 0.785 (0.611-0.977) in pediatric fractures, respectively. DISCUSSION The decision of union in tibia shaft fractures is based on repeated clinical and radiological evaluations but there are no universally accepted guidelines to evaluate radiographic union. It has been shown in previous studies that the RUST and mRUST scoring systems can be used safely in the evaluation of fracture healing in adult patients with tibia fracture treated with intra-medullary nailing. To our knowledge, there are no studies investigating the reliability of RUST and mRUST systems in conservatively treated pediatric tibial fractures. We hypothesized that the plaster of Paris makes it difficult to assess fracture union on direct radiographs and reduce the reliabilities of these scoring systems in pediatric tibial fractures. CONCLUSIONS Our study showed that both RUST and mRUST scoring systems are useful tools that can be used safely assessing fracture healing in both pediatric and adult tibia fractures. The presence of a plaster of Paris on the extremity did not adversely affect the inter-observer and intra-observer agreement of the RUST and mRUST scoring systems. Key words: pediatric tibia fracture, radiographic union score for tibial fracture (RUST), modified RUST, radiographic union, reliability.
- MeSH
- dítě MeSH
- dospělí MeSH
- fraktury tibie * diagnostické zobrazování chirurgie MeSH
- hojení fraktur MeSH
- intramedulární fixace fraktury * MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- reprodukovatelnost výsledků MeSH
- retrospektivní studie MeSH
- senioři MeSH
- síran vápenatý MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY Pauwels classification system is widely used to classify the femoral neck fractures. Even its widely usage there are severals debates about its reliability. After the femoral neck fracture occured the lower extremity rotates externally and this external rotation deformity could lead to misevaluation of Pauwels angle at the initial radiographs. The purpose of our study is to investigate whether the reliability of Pauwels classification increases after reduction of femoral neck fractures. MATERIAL AND METHODS Two power point presentation was prepared with 117 slides that include antero-posterior radiographs of each femoral neck fracture. The first one included preoperatively taken radiographs and the second one included early postoperatively taken radiographs. Eight observers evaluated these radiographs and they classified the fractures according to Pauwels classification system. After 3 months, the order of the slides were changed for each presentation and the observers were asked to evaluate the radiographs again. Intraclass correlation coefficient values were calculated for evaluation of inter- and intra-observer reliability. RESULTS The mean intra-observer agreement of preoperative evaluation was 0.406 (0.071-0.626) and the interobserver agreements were 0.263 (0.197-0.342) and 0.359 (0.287-0.447), respectively. The intra-observer agreement of postoperative evaluation was 0.508 (0.393-0.757), inter-observer agreements were 0.427 (0.353-0.509) and 0.431 (0.356-0.513), respectively. According to preoperative and postoperative evaluations, 6 of 8 observers' intra-observer agreements were found to be increased and the remaining 2 decreased. Interobserver reliability was improved from poor to fair-good values after evaluating the reducted fracture radiographs. DISCUSSION Femoral neck fractures(FNF) are common and anatomical reduction and internal fixation are preferred as a treatment option in young people and patients have good bone quality. Pauwels classification system is used for classify the FNF based on the shearing angle of the fracture line. As this angle increases, the fracture becomes unstable and nowadays stronger fixation devices are preferred for unstable fractures. Therefore, misevaluation of the fracture can lead to wrong treatment method selection. Non-optimal X-rays taken in the emergency rooms may cause misinterpretation of femoral neck fractures according to Pauwels classification system. We hypothized that the reliability of this classification system could be improved after reduction of the fracture. CONCLUSIONS Our study showed that classifying the femoral neck fracture according to Pauwels classification system is more confidential after the reduction, however we can not state that it's reliability is adequate. Key words: femoral neck fracture, Pauwels classification, reliability, inter-observer, intra-observer.
