Tibia Kırıklarında Radyolojik Kaynama Skorlama Sisteminin (RUST) güvenilirliği

Year 2014, Volume: 48 Issue: 5, 533 - 540, 12.11.2014

Erman Cekic Emin Alici Murat Yesil

https://doi.org/10.3944/AOTT.2014.14.0026

Abstract

Amaç: Bu çalışmanın amacı yakın zamanda geliştirilmiş olan Tibia Kırıklarında Radyolojik Kaynama Skorlama Sistemi (Radiographic Union Score for Tibial Fractures, RUST) ile tibia kırıklarının klinik sonuçları arasındaki korelasyonu araştırmaktı.

Çalışma planı: 2005 ile 2010 yılları arasında tibia şaft kırığı nedeniyle intramedüller çivileme uygulanan 41 hasta çalışmaya dahil edildi. Ortalama takip süresi 26,32 (dağılım: 12-48) ay idi. Hastaların takip sürecindeki klinik sonuçları  Karlström-Olerud fiziksel fonksiyon skalası, Görsel Ağrı Skalası (GAS) skoru ve Kısa Form-36  (KF-36) fiziksel fonksiyon ve ağrı skorlarıyla değerlendirildi. Ayrıca radyolojik değerlendirme sonrası hastaların Tibia  Kırıklarında Radyolojik Kaynama Skorlama Sistemi (RUST)  skorları kaydedildi.

Bulgular: Tibia Kırıklarında Radyolojik Kaynama Skorlama Sistemi’nin iyileşmeyi ve kaynamayı doğru bir şekilde gösterdiği görüldü (p<0.05). RUST skorunun diğer fiziksel ve ağrı skorlama sistemleri (KF-36, GAS, Karlström-Olerud) ile anlamlı şekilde korele olduğu saptandı.

Çıkarımlar: Tibia kırıklarının sonuçlarının değerlendirilmesinde RUST güvenilir bir sistem olarak gözükmektedir.

Keywords

Çivileme; intramedüller; kırık; RUST; skorlama; tibia.

Reliability of the Radiographic Union Score for Tibial Fractures

Abstract

Objective: The aim of this study was to investigate the correlation between the recently developed Radiographic Union Score for Tibial Fractures (RUST) scoring system and clinical outcomes in tibial fractures.

Methods: The study included 41 patients with tibia shaft fractures who underwent intramedullary nailing between 2005 and 2010. Mean follow-up period was 26.32 (range: 12 to 48) months. Clinical outcomes were measured using the Karlström-Olerud physical function scale, VAS score and SF-36 physical function and pain scores during follow-up. RUST scores were noted after radiological evaluation.

Results: RUST scores accurately reflected healing and union of the bone (p<0.05). RUST scoring also showed significant correlation with widely used physical and pain scoring systems (SF-36, VAS and Karlström-Olerud).

Conclusion: The RUST scoring system appears to be a reliable tool for the evaluation of  clinical outcomes in management of  tibial fracture.

Keywords

Nailing, intramedullary, fracture, RUST, scoring, tibia

References

• Checketts RG, Moran CG, Jennings AG. 134 tibial shaft fractures managed with the Dynamic Axial Fixator. Acta Orthop Scand 1995;66:271-4.
• Panjabi MM, Walter SD, Karuda M, White AA, Lawson JP. Correlations of radiographic analysis of healing fractures with strength: a statistical analysis of experimental osteotomies. J Orthop Res 1985;3:212-8.
• Whelan DB, Bhandari M, Stephen D, Kreder H, McKee MD, Zdero R, et al. Development of the radiographic union score for tibial fractures for the assessment of tibial fracture healing after intramedullary fixation. J Trauma 2010;68:629-32.
• Karlström G, Olerud S. Fractures of the tibial shaft; a critical evaluation of treatment alternatives. Clin Orthop Relat Res 1974;105:82-115.
• Downie WW, Leatham PA, Rhind VM, Wright V, Branco JA, Anderson JA. Studies with pain rating scales. Ann Rheum Dis 1978;37:378-81.
• Wewers ME, Lowe NK. A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health 1990;13:227-36.
• Gallagher EJ, Liebman M, Bijur PE. Prospective validation of clinically important changes in pain severity measured on a visual analog scale. Ann Emerg Med 2001;38:633-8.
• Ware JE Jr. SF-36 health survey update. Spine (Phila Pa 1976) 2000;25:3130-9.
• Egol KA, Gruson K, Spitzer AB, Walsh M, Tejwani NC. Do successful surgical results after operative treatment of long-bone nonunions correlate with outcomes? Clin Orthop Relat Res 2009;467:2979-85.
• Kooistra BW, Dijkman BG, Busse JW, Sprague S, Schemitsch EH, Bhandari M. The radiographic union scale in tibial fractures: reliability and validity. J Orthop Trauma 2010;24 Suppl 1:S81-6.
• Reed LK, Mormino MA. Functional outcome after blade plate reconstruction of distal tibia metaphyseal nonunions: a study of 11 cases. J Orthop Trauma 2004;18:81-6.
• Brinker MR, O’Connor DP. Exchange nailing of ununited fractures. J Bone Joint Surg Am 2007;89:177-88.
• Tükenmez M, Tezeren G. The treatment of adult segmented tibial shaft fractures with Ilizarov circular external fixator. Türkiye Klinikleri J Medical Sci 2007;27:379-85.
• Skoog A, Söderqvist A, Törnkvist H, Ponzer S. One-year outcome after tibial shaft fractures: results of a prospective fracture registry. J Orthop Trauma 2001;15:210-5.
• Corrales LA, Morshed S, Bhandari M, Miclau T 3rd. Variability in the assessment of fracture-healing in orthopaedic trauma studies. J Bone Joint Surg Am 2008;90:1862-8.
• Ware J Jr, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 1996;34:220-33. Sarmiento A, Sobol PA, Sew Hoy AL, Ross SD, Racette WL, Tarr RR. Prefabricated functional braces for the treatment of fractures of the tibial diaphysis. J Bone Joint Surg Am 1984;66:1328-39.
• Esterhai J, Alavi A, Mandell GA, Brown J. Sequential technetium-99m/gallium-67 scintigraphic evaluation of subclinical osteomyelitis complicating fracture nonunion. J Orthop Res 1985;3:219-25.
• Smith MA, Jones EA, Strachan RK, Nicoll JJ, Best JJ, Tothill P, et al. Prediction of fracture healing in the tibia by quantitative radionuclide imaging. J Bone Joint Surg Br 1987;69:441-7.
• Moed BR, Watson JT, Goldschmidt P, van Holsbeeck M. Ultrasound for the early diagnosis of fracture healing after interlocking nailing of the tibia without reaming. Clin Orthop Relat Res 1995;310:137-44.
• Gershuni DH, Skyhar MJ, Thompson B, Resnick D, Donald G, Akeson WH. A comparison of conventional radiography and computed tomography in the evaluation of spiral fractures of the tibia. J Bone Joint Surg Am 1985;67:1388-95.
• Tower SS, Beals RK, Duwelius PJ. Resonant frequency analysis of the tibia as a measure of fracture healing. J Orthop Trauma 1993;7:552-7.
• Keating JF, O’Brien PJ, Blachut PA, Meek RN, Broekhuyse HM. Locking intramedullary nailing with and without reaming for open fractures of the tibial shaft. A prospective, randomized study. J Bone Joint Surg Am 1997;79:334-41.
• Duwelius PJ, Schmidt AH, Rubinstein RA, Green JM. Nonreamed interlocked intramedullary tibial nailing. One community’s experience. Clin Orthop Relat Res 1995;315:104-13.
• Davis BJ, Roberts PJ, Moorcroft CI, Brown MF, Thomas PB, Wade RH. Reliability of radiographs in defining union of internally fixed fractures. Injury 2004;35:557-61.
• Morshed S, Corrales L, Genant H, Miclau T 3rd. Outcome assessment in clinical trials of fracture-healing. J Bone Joint Surg Am 2008;90 Suppl 1:62-7.
• Bhandari M, Guyatt GH, Swiontkowski MF, Tornetta P 3rd, Sprague S, Schemitsch EH. A lack of consensus in the assessment of fracture healing among orthopaedic surgeons. J Orthop Trauma 2002;16:562-6.
• Lane JM, Sandhu HS. Current approaches to experimental bone grafting. Orthop Clin North Am 1987;18:213
• Blokhuis TJ, de Bruine JH, Bramer JA, den Boer FC, Bakker FC, Patka P, et al. The reliability of plain radiography in experimental fracture healing. Skeletal Radiol 2001;30:151-6.
• Claes L, Grass R, Schmickal T, Kisse B, Eggers C, Gerngross H, et al. Monitoring and healing analysis of 100 tibial shaft fractures. Langenbecks Arch Surg 2002;387:146
• Whelan DB, Bhandari M, McKee MD, Guyatt GH, Kreder HJ, Stephen D, et al. Interobserver and intraobserver variation in the assessment of the healing of tibial fractures after intramedullary fixation. J Bone Joint Surg Br 2002;84:15-8. den Boer FC, Bramer JA, Patka P, Bakker FC, Barentsen RH, Feilzer AJ, et al. Quantification of fracture healing with three-dimensional computed tomography. Arch Orthop Trauma Surg 1998;117:345-50.
• Bhattacharyya T, Bouchard KA, Phadke A, Meigs JB, Kassarjian A, Salamipour H. The accuracy of computed tomography for the diagnosis of tibial nonunion. J Bone Joint Surg Am 2006;88:692-7.