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The Non-Union Scoring System: an interobserver reliability study

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

The Non-Union Scoring System (NUSS) aims to classify non-unions according to their severity and relate them to four treatment categories. The main purpose of this study was to evaluate the reliability of the NUSS. In addition we assessed its clinical validity.

Methods

Forty-four Patients with a tibia non-union between 2005 and 2015 were included in this study. Data from all included patients were scored independently by three observers according to the NUSS criteria. The interobserver agreement was evaluated using the intraclass correlation coefficient (ICC). The interobserver agreement of the Weber–Cech system was assessed using Fleiss’ kappa. Finally, the clinical validity of the NUSS was analysed by comparing outcomes of the actual treatment groups to the proposed treatment groups following from the NUSS scores.

Results

Forty-four patients were included. The comparison of NUSS scores between observers showed substantial agreement [ICC; 0.78 (0.67–0.86)]. The comparison of the Weber–Cech classification between observers showed only fair agreement [Fleiss κ; 0.30 (0.17–0.42)]. The χ2 test for the treatment groups according to the NUSS and the treatments at index procedure showed an independent relation (χ2 = 5.794, 6 degrees of freedom, p: 0.447). In contrast, the proposed treatment strategy corresponds well to the definitive treatment (χ2 = 29.963, 9 degrees of freedom, p < 0.001).

Conclusion

We conclude that the NUSS is both a reliable and valid system to classify non-unions.

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Authors and Affiliations

  1. Department of Surgery, University Medical Center Utrecht, Voorstraat 98b, 3512 AV, Utrecht, The Netherlands

    M. van Basten Batenburg & I. B. Houben

  2. Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands

    T. J. Blokhuis

Authors
  1. M. van Basten Batenburg
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  2. I. B. Houben
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  3. T. J. Blokhuis
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Corresponding author

Correspondence to M. van Basten Batenburg.

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Conflict of interest

M. van Basten Batenburg, I. B. Houben and T.J. Blokhuis declare that they have no conflict of interest.

Research involving human and animal participants

Since this study solely used retrospective data, neither humans nor animals participated actively in the study.

Informed consent

The retrieval of data was covered by the general institutional review board (IRB) approval for data analysis in our institution.

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van Basten Batenburg, M., Houben, I.B. & Blokhuis, T.J. The Non-Union Scoring System: an interobserver reliability study. Eur J Trauma Emerg Surg 45, 13–19 (2019). https://doi.org/10.1007/s00068-017-0796-4

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  • DOI: https://doi.org/10.1007/s00068-017-0796-4

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