Top

Published in:

01-08-2013 | Scientific Article

The Radiographic Union Score for Hip (RUSH): the use of a checklist to evaluate hip fracture healing improves agreement between radiologists and orthopedic surgeons

Authors: Mary M. Chiavaras, Simrit Bains, Hema Choudur, Naveen Parasu, Jon Jacobson, Olufemi Ayeni, Brad Petrisor, Rajesh Chakravertty, Sheila Sprague, Mohit Bhandari

Published in: Skeletal Radiology | Issue 8/2013

Abstract

Objective

The assessment of fracture healing following intertrochanteric fracture fixation is highly variable with no validated standards. Agreement with respect to fracture healing following surgery is important for optimal patient management. The purpose of this study was to (1) assess reliability of intertrochanteric fracture healing assessment and (2) determine if a novel radiographic scoring system for hip fractures improves agreement between radiologists and orthopedic surgeons.

Materials and methods

A panel of three radiologists and three orthopedic surgeons assessed fracture healing in 150 cases of intertrochanteric fractures at two separate time points to determine inter-rater and intra-rater agreement. Reviewers, blinded to the time after injury, first subjectively assessed overall healing using frontal and lateral radiographs for each patient at a single time point. Reviewers then scored each fracture using a Radiographic Union Score for Hip (RUSH) form to determine whether this improves agreement regarding hip fracture healing.

Results

Inter-rater agreement for the overall subjective impression of fracture healing between reviewer groups was only fair (intraclass coefficient [ICC] = 0.34, 95 % CI: 0.11–0.52. Use of the RUSH score improved overall agreement between groups to substantial (ICC = 0.66, 95 % CI: 0.53–0.75). Across reviewers, healing of the medial cortex and overall RUSH score itself demonstrated high correlations with overall perceptions of healing (r = 0.53 and r = 0.72, respectively).

Conclusions

The RUSH score improves agreement of fracture healing assessment between orthopedic surgeons and radiologists, offers a systematic approach to evaluating intertrochanteric hip fracture radiographs, and may ultimately provide prognostic information that could predict healing outcomes in patients with femoral neck fractures.

Johnell O, Kanis JA. An estimate of the worldwide prevalence, mortality and disability associated with hip fracture. Osteoporos Int. 2004;15(11):897–902.PubMedCrossRef

Randell AG, Nguyen TV, Bhalerao N, Silverman SL, Sambrook PN, Eisman JA. Deterioration in quality of life following hip fracture: a prospective study. Osteoporos Int. 2000;11:460–6.PubMedCrossRef

Zuckerman JD. Current concepts: hip fracture. N Engl J Med. 1996;334(23):1519–25.PubMedCrossRef

Bhandari M, Guyatt GH, Swiontkowski MF, Tornetta 3rd P, Sprague S, Schemitsch EH. A lack of consensus in the assessment of fracture healing among orthopaedic surgeons. J Orthop Trauma. 2002;16:562–6.PubMedCrossRef

Vannabouathong C, Sprague S, Bhandari M. Guidelines for fracture healing assessments in clinical trials. Part I: definitions and endpoint committees. Injury. 2011;42:314–6.PubMedCrossRef

Corrales LA, Morshed S, Bhandari M, Miclau T. Variability in the assessment of fracture-healing in orthopaedic trauma studies. J Bone Joint Surg Am. 2008;90:1862–8.PubMedCrossRef

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 Bone Joint Surg Am. 2002;84-B:15–8.CrossRef

Johansson T, Jacobsson S, Ivarsson I, Knutsson A, Wahlstrom O. Internal fixation versus total hip arthroplasty in the treatment of displaced femoral neck fractures: a prospective randomized study of 100 hips. Acta Orthop Scand. 2000;71(6):597–602.PubMedCrossRef

Elmerson S, Sjostedt A, Zetterberg C. Fixation of femoral neck fracture: a randomized 2-year follow-up study of hook pins and sliding screw plate in 222 patients. Acta Orthop Scand. 1995;66(6):507–10.PubMedCrossRef

10.

Dijkman BG, Sprague S, Schemitsch EH, Bhandari M. When is a fracture healed? Radiographic and clinical criteria revisited. J Orthop Trauma. 2010;24:S76–80.PubMedCrossRef

11.

Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.PubMedCrossRef

12.

Manninger J, Bosch U, Cserhati P, Fekete K, Kazar G, editors. Internal fixation of femoral neck fractures. Chapter 1: Proximal femur fractures. Definition, epidemiology, anatomy, biomechanics. Vienna: Springer; 2007.

13.

Ahn J, Bernstein J. In brief: fractures in brief: intertrochanteric hip fractures. Clin Orthop Relat Res. 2010;468:1450–2.PubMedCrossRef

14.

Parker MJ, Handoll HHG. Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. Cochrane Libr. 2010 [Epub].

15.

Audige L, Bhandari M, Kellam J. How reliable are reliability studies of fracture classifications? A systematic review of their methodologies. Acta Orthop Scand. 2004;75(2):184–94.PubMedCrossRef

16.

Gehrchen PM, Nielsen JO, Olesen B, Andresen BK. Seinsheimer’s classification of subtrochanteric fractures: poor reproducibility of 4 observers’ evaluation of 50 cases. Acta Orthop Scand. 1997;68(6):524–6.PubMedCrossRef

17.

Gehrchen PM, Nielsen JO, Olesen B. Poor reproducibility of Evans’ classification of the trochanteric fracture: assessment of 4 observers in 52 cases. Acta Orthop Scand. 1993;64(1):71–2.PubMedCrossRef

18.

Andersen E, Jorgensen LG, Hededam LT. Evans’ classification of trochanteric fractures: an assessment of the interobserver and intraobserver reliability. Injury. 1990;21:377–8.PubMedCrossRef

19.

Pervez H, Parker MJ, Pryor GA, Lutchman L, Chirodian N. Classification of trochanteric fracture of the proximal femur: a study of the reliability of current systems. Injury. 2002;33(8):713–5.PubMedCrossRef

20.

Jin W-J, Dai L-Y, Cui Y-M, Zhou Q, Jiang L-S, Lu H. Reliability of classification systems for intertrochanteric fractures of the proximal femur in experienced orthopaedic surgeons. Injury. 2005;36(7):858–61.PubMedCrossRef

21.

Memisoglu S, Eskin D, Yamak E, Gurbuz A, Saridogan K, Dulger H. Which classification system is more useful for intertrochanteric fractures? AO/ASIF or Jensen? Trakya Univ Tip Fak Derg. 2008;25(3):181–5.

22.

Fung W, Jonsson A, Buhren V, Bhandari M. Classifying intertrochanteric fractures of the proximal femur: does experience matter? Med Princ Pract. 2007;16:198–202.PubMedCrossRef

23.

Van Embden D, Rhemrev SJ, Meylaerts SAG, Roukema GR. The comparison of two classifications for trochanteric femur fractures: the AO/ASIF classification and the Jensen classification. Injury. 2010;41:377–81.PubMedCrossRef

24.

Sidor ML, Zuckerman JD, Lyon T, Koval K, Cuomo F, Schoenberg N. The Neer classification system for proximal humeral fractures. An assessment of interobserver reliability and intraobserver reproducibility. J Bone Joint Surg Am. 1993;75:1745–50.PubMed

25.

Hammer RRR, Hammerby S, Lindholm B. Accuracy of radiologic assessment of tibial shaft fracture union in humans. Clin Orthop Relat Res. 1985;199:233–8.PubMed

26.

McClelland D, Thomas PBM, Bancroft G, Moorcroft CI. Fracture healing assessment comparing stiffness measurements using radiographs. Clin Orthop Relat Res. 2007;457:214–9.PubMed

27.

Martin J, Marsh JL, Nepola JV, Dirschl DR, Hurwitz S, DeCoster TA. Radiographic fracture assessments: which ones can we reliably make? Orthop Trauma. 2000;14(6):379–85.

28.

Wade R, Richardson J. Outcomes in fracture healing: a review. Injury. 2001;32(2):109–14.PubMedCrossRef

29.

Morshed S, Corrales L, Genant H, Miclau T. Outcome assessment in clinical trials of fracture-healing. J Bone Joint Surg Am. 2008;90:62–7.PubMedCrossRef

30.

Blokhuis TJ, de Bruine JHD, Bramer JAM, den Boer FC, Bakker FC, Patka P, et al. The reliability of plain radiography in experimental fracture healing. Skeletal Radiol. 2001;30:151–6.PubMedCrossRef

31.

Kooistra BW, Sprague S, Bhandari M, Schemitsch EH. Outcomes assessment in fracture healing trials: a primer. Orthop Trauma. 2010;24:S71–5.

32.

Crewson PE. Fundamentals of clinical research for radiologists: reader agreement studies. AJR Am J Roentgenol. 2005;184:1391–7.PubMedCrossRef

Title: The Radiographic Union Score for Hip (RUSH): the use of a checklist to evaluate hip fracture healing improves agreement between radiologists and orthopedic surgeons
Authors: Mary M. Chiavaras
Simrit Bains
Hema Choudur
Naveen Parasu
Jon Jacobson
Olufemi Ayeni
Brad Petrisor
Rajesh Chakravertty
Sheila Sprague
Mohit Bhandari
Publication date: 01-08-2013
Publisher: Springer-Verlag
Published in: Skeletal Radiology / Issue 8/2013
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI: https://doi.org/10.1007/s00256-013-1605-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The Radiographic Union Score for Hip (RUSH): the use of a checklist to evaluate hip fracture healing improves agreement between radiologists and orthopedic surgeons

Abstract

Objective

Materials and methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objective

Materials and methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 8/2013

Biomechanical properties of the calcaneal tendon in vivo assessed by transient shear wave elastography

Browser’s Notes

Rapid osteolysis of the femoral neck: consequence of an insufficiency fracture of the hip?

MPR realignment increases accuracy when measuring femoral neck anteversion angle

Post-traumatic pseudoaneurysm of the thyrocervical trunk

Determination of a reference system for the three-dimensional study of the glenohumeral relationship