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Current Medical Imaging

Author(s): Ali Yüce*, Gokhan Karahan and Levent Kucuk

DOI: 10.2174/1573405618666220627124459

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Intra-Observational and Inter-Observer Agreement of The Radiographic Humerus Union Measurement (RHUM) in Patients Treated with Dynamic Compression Plate for Humeral Shaft Nonunion

Article ID: e270622206410 Pages: 7

  • * (Excluding Mailing and Handling)

Abstract

Background: It is important for orthopedic surgeons to follow the union of the fracture after surgery. This becomes even more important after nonunion surgery. The radiological union scale is popular in the follow-up of unions. However, the intraobserver and interobserver agreement of this scale in humeral nonunion surgery is still not found in the literature.

Objective: This study aimed to reveal the intra/interobserver agreement of the Radiographic Union scale (RHUM) for the humerus as well as the relationship between this agreement, plate placement characteristics, and the number of plates in cases where plates were used for surgical treatment of humeral diaphysis nonunion.

Materials and Methods: Twenty patients who received surgical treatment for aseptic humeral nonunion at our hospital between 2010-2019 were studied retrospectively. According to RHUM, two observers scored the patients' anteroposterior and lateral radiographs in the postoperative 12th week. The data obtained were statistically analyzed.

Results: The mean age was 52.05±15.88 years. While a single plate was used in 14 cases, a double plate was used in 6 cases. Interobserver agreement was fair-moderate. The interobserver agreement values of the single plate group were significantly higher than those of the double plate group (p<0.05). Interobserver agreement in cases with a lateral plate was significantly higher than in the group where the lateral + posterior plate was applied (p:0.01).

Conclusion: In humeral diaphyseal fracture nonunion cases, the number and location of the plate following surgery negatively impact the evaluation of RHUM scores. Given the importance of the union's follow-up and the decision to proceed with additional treatment in these cases, it may be necessary to develop a new method for determining and monitoring the union if a plate was used in the surgical treatment of humeral nonunion.

Keywords: Humerus, radiographic union, RHUM score, interrater agreement, humeral shaft nonunion, RUST score.

Graphical Abstract

[1]
Oliver WM, Smith TJ, Nicholson JA, et al. The Radiographic Union Score for HUmeral fractures (RUSHU) predicts humeral shaft nonunion. Bone Joint J 2019; 101-B(10): 1300-6.
[http://dx.doi.org/10.1302/0301-620X.101B10.BJJ-2019-0304.R1] [PMID: 31564159]
[2]
Nicholson JA, Makaram N, Simpson A, Keating JF. Fracture nonunion in long bones: A literature review of risk factors and surgical management. Injury 2021; 52 (Suppl. 2): S3-S11.
[http://dx.doi.org/10.1016/j.injury.2020.11.029] [PMID: 33221036]
[3]
Rupp M, Biehl C, Budak M, Thormann U, Heiss C, Alt V. Diaphyseal long bone nonunions - types, aetiology, economics, and treatment recommendations. Int Orthop 2018; 42(2): 247-58.
[http://dx.doi.org/10.1007/s00264-017-3734-5] [PMID: 29273837]
[4]
Ali MI. Management for locking compression plate/dynamic compression plate implant failure in non union osteoporotic humerus shaft bone fracture. Apollo Med 2016; 13(2): 123-6.
[http://dx.doi.org/10.1016/j.apme.2015.04.001]
[5]
Mundi R, Axelrod D, Chaudhry H, Sahota N. Heels- Ansdell D, Sprague S, Petrisor B, Schemitsch E, Busse JW, Thabane L, Bhandari M. Association of three-month radiographic union score for tibia fractures (RUST) with nonunion in tibial shaft fracture patients. Cureus 2020; 12(5)e8314
[http://dx.doi.org/10.7759/cureus.8314] [PMID: 32607297]
[6]
Wittauer M, Burch MA, McNally M, et al. Definition of long-bone nonunion: A scoping review of prospective clinical trials to evaluate current practice. Injury 2021; 52(11): 3200-5.
[http://dx.doi.org/10.1016/j.injury.2021.09.008] [PMID: 34531088]
[7]
Christiano AV, Goch AM, Leucht P, Konda SR, Egol KA. Radiographic union score for tibia fractures predicts success with operative treatment of tibial nonunion. J Clin Orthop Trauma 2019; 10(4): 650-4.
[http://dx.doi.org/10.1016/j.jcot.2018.10.010] [PMID: 31316233]
[8]
Leow JM, Clement ND, Tawonsawatruk T, Simpson CJ, Simpson AHRW. The radiographic union scale in tibial (RUST) fractures: Reliability of the outcome measure at an independent centre. Bone Joint Res 2016; 5(4): 116-21.
[http://dx.doi.org/10.1302/2046-3758.54.2000628] [PMID: 27073210]
[9]
Misir A, Uzun E, Kizkapan TB, Yildiz KI, Onder M, Ozcamdalli M. Reliability of RUST and modified RUST scores for the evaluation of union in humeral shaft fractures treated with different techniques. Indian J Orthop 2020; 54(S1) (Suppl. 1): 121-6.
[http://dx.doi.org/10.1007/s43465-020-00182-8] [PMID: 32952919]
[10]
Christiano AV, Goch AM, Burke CJ, Leucht P, Konda SR, Egol KA. Radiographic humerus union measurement (RHUM) demonstrates high inter- and intraobserver reliability in assessing humeral shaft fracture healing. HSS J 2020; 16(S2) (Suppl. 2): 216-20.
[http://dx.doi.org/10.1007/s11420-019-09680-4] [PMID: 33380949]
[11]
Christiano AV, Pean CA, Leucht P, Konda SR, Egol KA. Scoring of radiographic cortical healing with the radiographic humerus union measurement predicts union in humeral shaft fractures. Eur J Orthop Surg Traumatol 2020; 30(5): 835-8.
[http://dx.doi.org/10.1007/s00590-020-02635-0] [PMID: 32034464]
[12]
Schneble CA, Li DT, Kahan J, et al. Reliability of radiographic union scoring in humeral shaft fractures. J Orthop Trauma 2020; 34(12): e437-41.
[http://dx.doi.org/10.1097/BOT.0000000000001811] [PMID: 32427814]
[13]
Babhulkar S, Pande K, Babhulkar S. Nonunion of the diaphysis of long bones. Clin Orthop Relat Res 2005; (431): 50-6.
[http://dx.doi.org/10.1097/01.blo.0000152369.99312.c5] [PMID: 15685055]
[14]
Atwan Y, Schemitsch EH. Radiographic evaluations: Which are most effective to follow fracture healing? Injury 2020; 51(2) (Suppl. 2): S18-22.
[http://dx.doi.org/10.1016/j.injury.2019.12.028] [PMID: 31983424]
[15]
Litrenta J, Tornetta P III, Mehta S, et al. Determination of Radiographic Healing: An Assessment of Consistency Using RUST and Modified RUST in Metadiaphyseal Fractures. J Orthop Trauma 2015; 29(11): 516-20.
[http://dx.doi.org/10.1097/BOT.0000000000000390] [PMID: 26165265]
[16]
Frank T, Osterhoff G, Sprague S, Garibaldi A, Bhandari M, Slobogean GP. The Radiographic Union Score for Hip (RUSH) identifies radiographic nonunion of femoral neck fractures. Clin Orthop Relat Res 2016; 474(6): 1396-404.
[http://dx.doi.org/10.1007/s11999-015-4680-4] [PMID: 26728521]
[17]
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(11): 2979-85.
[http://dx.doi.org/10.1007/s11999-009-0883-x] [PMID: 19437084]
[18]
Peters RM, Claessen FM, Doornberg JN, Kolovich GP, Diercks RL, van den Bekerom MP. Union rate after operative treatment of humeral shaft nonunion--A systematic review. Injury 2015; 46(12): 2314-24.
[http://dx.doi.org/10.1016/j.injury.2015.09.041] [PMID: 26499226]
[19]
Sügün TS, Özaksar K, Toros T, Kayalar M, Bal E, Özerkan F. Humerus Cisim Kaynamamaları: Plaklar ve Çiviler. Jt Dis Relat Surg 2012; 23(3): 150-5.
[20]
van Houten AH, Heesterbeek PJ, van Heerwaarden RJ, van Tienen TG, Wymenga AB. Medial open wedge high tibial osteotomy: Can delayed or nonunion be predicted? Clin Orthop Relat Res 2014; 472(4): 1217-23.
[http://dx.doi.org/10.1007/s11999-013-3383-y] [PMID: 24249537]
[21]
Buckwalter KA, Parr JA, Choplin RH, Capello WN. Multichannel CT imaging of orthopedic hardware and implants. Semin Musculoskelet Radiol 2006; 10(1): 86-97.
[http://dx.doi.org/10.1055/s-2006-934219] [PMID: 16514583]
[22]
Wellenberg RHH, Donders JCE, Kloen P, et al. Exploring metal artifact reduction using dual-energy CT with pre-metal and post-metal implant cadaver comparison: Are implant specific protocols needed? Skeletal Radiol 2018; 47(6): 839-45.
[http://dx.doi.org/10.1007/s00256-017-2750-2] [PMID: 28842739]