• Arch Orthop Trauma Surg · Dec 2024

    A modified Radiographic Union Score for Tibia (RUST) scoring system for patella fractures treated with osteosynthesis shows excellent intra und interobserver reliability.

    • Julia Elisabeth Lenz, Lorenz Huber, Dominik Szymski, Volker Alt, Markus Rupp, and Johannes Weber.
    • University Hospital Regensburg, Regensburg, Germany. julia1.lenz@ukr.de.
    • Arch Orthop Trauma Surg. 2024 Dec 27; 145 (1): 9898.

    IntroductionPatellar fractures are rare at 1% incidence of all fractures. However, they can cause significant functional impairments due to the patella's role in knee joint extension. Current scoring systems lack objectivity in assessing patellar healing. This study aims to validate the Radiographic Union Score for Tibia (RUST) using biplanar radiographs for assessing surgically treated patellar fractures.Materials And MethodsA retrospective analysis of radiological follow-up examinations was conducted on patients undergoing surgical treatment for patellar fractures from January 1st 2013, to June 30th 2023. Thirty patients were randomly selected, yielding 105 postoperative X-rays representing various healing stages. The modified Radiographic Union Score for Tibia (RUST) was applied to these X-rays by three independent trauma surgeons. Radiological follow-up examinations were randomized, pseudonymized, and stored on a hospital server for blinded assessment by three raters. The modified RUST assessed continuity of patellar borders and cortexes, assigning scores based on cortical bridging. Interobserver and intraobserver reliability were evaluated using intraclass correlation coefficients (ICC), adhering to recommended sample size criteria and interpretation guidelines.ResultsThe mean modified RUST was 9.1 ± 2.2 points, with scores ranging from 4 to 12 points. The interobserver intraclass correlation coefficient (ICC) was 0.88 (95% CI, 0.81-0.92) and the intraobserver ICC were 0.6 (95% CI, 0.65-0.84), 0.80 (95% CI, 0.71-0.87) and 0.98 (0.98-0.99) respectively, which indicated good to excellent agreement.ConclusionsThis study validated the Radiographic Union Score for Tibia (RUST) for evaluating bone healing in patellar fractures treated with osteosynthesis, demonstrating good intra- and interobserver reliability. The modified RUST can provide a standardized method for assessing healing in patellar fractures, benefiting both clinical practice and clinical trials.© 2024. The Author(s).

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