Title: Inter and Intra Observer Reliability of RUST score in Open Tibial Fractures treated with Intramedullary Nailing
Authors: Neeti Aggarwal, Vineet Aggarwal, Rudra Pratap Singh Thakur, Sanjiv Sharma
DOI: https://dx.doi.org/10.18535/jmscr/v5i10.11
Abstract
Introduction: The Radiological healing score for tibia is a useful instrument to quantify fracture healing in tibial fractures. It is a validated score showing strong to almost perfect agreement between observers. The present study tends to evaluate the results of the score when applied on open tibial fractures stabilized with an intramedullary device.
Material and Methods: 60 cases of open tibial fractures that underwent intramedullary nailing were evaluated for fracture healing using the RUST score. 40 prospective cases and 20 retrospective cases were evaluated radiographically using standardized radiographs. Four observers, two of whom were orthopedic surgeons and two were radiologists, independently evaluated the radiographs to determine a score. Interobserver reliability and Intraobserver reliability was statistically calculated using the interclass correlation co-efficient (ICC).
Results: This was a longitudinal cohort study involving 60 patients who were treated for open tibial fractures. At 6 months the median RUST scores for all 60 patients were 9.5. At 6 months the interobserver agreement was excellent and statistically significant (ICC 0.911).
For the prospective cases, The Inter-rater agreement amongst observers for RUST score was found to be good and statistically significant at 6 weeks (ICC 0.872) that improved to excellent at 6 months (ICC 0.962).
Discussion: Radiological assessment of fracture healing is accepted universally due to its availability and low costs. However, it is still a subjective interpretation of data and can be misleading. The RUST score tends to address these shortcomings by applying a numerical value to various parameters visible on radiographs. To avoid the pitfall of subjectivity, the score has been subsequently validated in studies applying inter and intra observer reliability when independently observed by number of evaluators. This study tends to confirm that there is an almost perfect agreement amongst observers across various specialties when the RUST score is applied for open tibial fractures treated with intramedullary nailing.
Keywords- Tibial fractures, RUST score, Intramedullary nailing, Interobserver reliability.
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