Anna J. L. Lodewijks (Maastricht / NL), Lotte C. A. van der Broeck (Maastricht / NL), Daan Loeffen (Maastricht / NL), Jan Geurts (Maastricht / NL), Martijn Poeze (Maastricht / NL), Taco J. Blokhuis (Maastricht / NL)
Introduction
Radiographic assessment of bone healing is challenging, especially in postoperative bone defects and non-union. For clinical practice, and in particular research, quantification of bone healing can be of interest. Scores, such as the (modified) Radiographic Union Score for Tibial fractures ((m)RUST) are widely known. The Lane-Sandhu score, a lesser-known score for bone defects, may have benefits over the mRUST score. The aim of this study is to compare inter- and intraobserver reliability of the Lane-Sandhu score with the mRUST.
Methods
First, five postoperative radiographs were scored by five observers using the mRUST and modified Lane-Sandhu score individually. Pitfalls of the scores were thereafter analyzes in a trainings session. Finally, each observer scored ten new radiographs. The intraclass correlation coefficient (ICC) was calculated to determine intra- and interobserver reliability of the scores for each session. Sub analyses were performed for different fixation methods.
Results
The pilot session resulted in an interobserver reliability of 0.48 for the mRUST and -0.049 for the Lane-Sandhu score. During the training session, the interobserver reliability scores were 0.50 and 0.14 respectively. The final session resulted in an ICC of 0.79 (95% CI 0.60-0.91) for the mRUST and 0.76 (0.59-0.88) for the Lane-Sandhu. Both reliability scores are classified as good with no statistical significant difference between the two scores. The reliability was similar in different fixation methods.
Conclusion
Both scores are reliable scoring systems for the interpretation of postoperative bone defects and nonunion. There is a slight preference for the mRUST because the reliability was less dependent on the training session. For future research, the interpretation of postoperative radiographs should be well described and a training session is recommended.
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