Zhu Tong,Zheng Haolin,Jia Guoqiang,et al.Inter/intra-observer reliability of evaluating femoral shaft fracture healing in children through Modified Radiographic Union Score for Tibial Fractures (MRUST)[J].Journal of Clinical Pediatric Surgery,,22():533-537.[doi:10.3760/cma.j.cn101785-202206041-007]
Inter/intra-observer reliability of evaluating femoral shaft fracture healing in children through Modified Radiographic Union Score for Tibial Fractures (MRUST)
- Keywords:
- Modified Radiographic Union Score for Tibial fractures (MRUST); Femoral Shaft Fractures; Radiography; Fracture Healing; Treatment Outcome; Reproducibility of Results; Child
- Abstract:
- Objective To assess inter/intra-observer reliability of evaluating femoral shaft fracture healing in children through Modified Radiographic Union Score for Tibial Fractures (MRUST) and provide theoretical rationales for weight-bearing management and bone healing after femoral shaft fractures in children.Methods A total of 45 sets (i.e.AP & lateral) of radiographs of femoral shaft fractures in children treated by elastic stable intramedullary nailing (ESIN) within 4-8 weeks post-operation were scored thrice.The intraclass correlation coefficient (ICC) with 95% confidence intervals was utilized for quantifying inter/intra-observer agreement of MRUST score.Results RUST scores of all 45 radiographs were measured.The values of MRUST score ranged from 4 to 12 with a mean score of 9.02[standard deviation (SD) 1.94].The overall ICC score was 0.81 (95%CI, 0.74 to 0.88).Among three observers, inter-observer agreement was strong with ICC of 0.74 (95%CI, 0.62-0.84), 0.88 (95%CI, 0.82 to 0.93) and 0.88 (95%CI, 0.8 to 0.92).After averaging the observations of observers, inter-observer agreement was strong with ICC of 0.92 (95%CI, 0.88 to 0.95).The intra-observer agreement was strong with ICC of 0.93 (95%CI, 0.89 to 0.96), 0.78 (95%CI, 0.68 to 0.87) and 0.73 (95%CI, 0.60 to 0.83).After averaging the observations of observers, the agreement of intra-observer was strong with ICC of 0.89 (95%CI, 0.83 to 0.94).Conclusion With excellent inter/intra-observer reliability agreements in evaluating femoral shaft fracture healing in children, MRUST scoring system provides theoretical rationales for weight-bearing management and bone healing.
References:
[1] Kocher MS, Sink EL, Blasier RD, et al.Treatment of pediatric diaphyseal femur fractures[J].J Am Acad Orthop Surg, 2009, 17(11):718-725.DOI:10.5435/00124635-200911000-00006.
[2] Loder RT, O’Donnell PW, Feinberg JR.Epidemiology and mechanisms of femur fractures in children[J].J Pediatr Orthop, 2006, 26(5):561-566.DOI:10.1097/01.bpo.0000230335.19029.ab.
[3] Lascombes P, Haumont T, Journeau P.Use and abuse of flexible intramedullary nailing in children and adolescents[J].J Pediatr Orthop, 2006, 26(6):827-834.DOI:10.1097/01.bpo.0000235397.64783.d6.
[4] Flynn JM, Hresko T, Reynolds RA, et al.Titanium elastic nails for pediatric femur fractures:a multicenter study of early results with analysis of complications[J].J Pediatr Orthop, 2001, 21(1):4-8.DOI:10.1097/00004694-200101000-00003.
[5] Kocher MS, Sink EL, Blasier RD, et al.American Academy of Orthopedic Surgeons clinical practice guideline on treatment of pediatric diaphyseal femur fracture[J].J Bone Joint Surg Am, 2010, 92(8):1790-1792.DOI:10.2106/JBJS.J.00137.
[6] Roaten JD, Kelly DM, Yellin JL, et al.Pediatric femoral shaft fractures:a multicenter review of the AAOS clinical practice guidelines before and after 2009[J].J Pediatr Orthop, 2019, 39(8):394-399.DOI:10.1097/BPO.0000000000000982.
[7] Naranje SM, Stewart MG, Kelly DM, et al.Changes in the treatment of pediatric femoral fractures:15-year trends from united states kids’ inpatient database (KID) 1997 to 2012[J].J Pediatr Orthop, 2016, 36(7):e81-e85.DOI:10.1097/BPO.0000000000000633.
[8] Maier M, Maier-Heidkamp P, Lehnert M, et al.Results of femoral shaft fractures in childhood in relation to different treatment modalities[J].Unfallchirurg, 2003, 106(1):48-54.DOI:10.1007/s00113-002-0481-9.
[9] Houshian S, G?thgen CB, Pedersen NW, et al.Femoral shaft fractures in children:elastic stable intramedullary nailing in 31 cases[J].Acta Orthop Scand, 2004, 75(3):249-251.DOI:10.1080/00016470410001150.
[10] Bhandari M, Guyatt GH, Swiontkowski MF, et al.A lack of consensus in the assessment of fracture healing among orthopaedic surgeons[J].J Orthop Trauma, 2002, 16(8):562-566.DOI:10.1097/00005131-200209000-00004.
[11] Kooistra BW, Dijkman BG, Busse JW, et al.The radiographic union scale in tibial fractures:reliability and validity[J].J Orthop Trauma, 2010, 24(Suppl 1):S81-S86.DOI:10.1097/BOT.0b013e3181ca3fd1.
[12] Whelan DB, Bhandari M, McKee MD, et al.Interobserver and intraobserver variation in the assessment of the healing of tibial fractures after intramedullary fixation[J].J Bone Joint Surg Br, 2002, 84-B(1):15-18.DOI:10.1302/0301-620x.84b1.11347.
[13] Li J, Rai S, Ze RH, et al.Distal third femoral shaft fractures in school-aged children:a comparative study of elastic stable intramedullary nail and external fixator[J].Medicine (Baltimore), 2020, 99(27):e21053.DOI:10.1097/MD.0000000000021053.
[14] Whelan DB, Bhandari M, Stephen D, et al.Development of the radiographic union score for tibial fractures for the assessment of tibial fracture healing after intramedullary fixation[J].J Trauma, 2010, 68(3):629-632.DOI:10.1097/TA.0b013e3181a7c16d.
[15] Leow JM, Clement ND, Tawonsawatruk T, et al.The radiographic union scale in tibial(RUST)fractures:reliability of the outcome measure at an Independent centre[J].Bone Joint Res, 2016, 5(4):116-121.DOI:10.1302/2046-3758.54.2000628.
[16] Sarmiento A, Sobol PA, Sew Hoy AL, et al.Prefabricated functional braces for the treatment of fractures of the tibial diaphysis[J].J Bone Joint Surg Am, 1984, 66(9):1328-1339.
[17] Joslin CC, Eastaugh-Waring SJ, Hardy JRW, et al.Weight bearing after tibial fracture as a guide to healing[J].Clin Biomech (Bristol, Avon), 2008, 23(3):329-333.DOI:10.1016/j.clinbiomech.2007.09.013.
[18] Hammer R, Norrbom H.Evaluation of fracture stability.A mechanical simulator for assessment of clinical judgement[J].Acta Orthop Scand, 1984, 55(3):330-333.DOI:10.3109/17453678408992367.
[19] Morshed S.Current options for determining fracture union[J].Adv Med, 2014, 2014:708574.DOI:10.1155/2014/708574.
[20] Perlepe V, Cerato A, Putineanu D, et al.Value of a radiographic score for the assessment of healing of nailed femoral and tibial shaft fractures:a retrospective preliminary study[J].Eur J Radiol, 2017, 98:36-40.DOI:10.1016/j.ejrad.2017.10.020.
[21] Bukvi? N, Kvesi? A, Brekalo Z, et al.The validity of ESIN method of osteosynthesis compared to other active surgical methods of treatment of diaphyseal fractures of long bones in children and adolescents[J].Coll Antropol, 2011, 35(2):403-408.
[22] Ligier JN, Metaizeau JP, Prévot J, et al.Elastic stable intramedullary nailing of femoral shaft fractures in children[J].J Bone Joint Surg Br, 1988, 70(1):74-77.DOI:10.1302/0301-620X.70B1.3339064.
[23] Lardelli P, Frech-D?rfler M, Holland-Cunz S, et al.Slow recovery of weight bearing after stabilization of long-bone fractures using elastic stable intramedullary nails in children[J].Medicine (Baltimore), 2016, 95(11):e2966.DOI:10.1097/MD.0000000000002966.
Memo
收稿日期:2022-06-16。
通讯作者:王恩波,Email:wangenbodor@163.com