Two-part study using 12 trauma surgeons and prospective data from two multicenter RCTs (SOLVED and IMPRESS) to establish interrater reliability of the RUST and modified RUST scoring systems and define data-driven score thresholds for radiographic union in metadiaphyseal fractures treated with plates or nails.
When determining radiographic union in distal femur or proximal tibia fractures, use RUST ≥ 10 or modified RUST ≥ 13 as the threshold for definite union — scores below these are ambiguous and should prompt clinical correlation.
Keep in mind that plate-fixed fractures unite at lower scores than nail-fixed fractures, so applying a single threshold without accounting for fixation method will overestimate healing in plated constructs.
Two-part study using 12 trauma surgeons and prospective data from two multicenter RCTs (SOLVED and IMPRESS) to establish interrater reliability of the RUST and modified RUST scoring systems and define data-driven score thresholds for radiographic union in metadiaphyseal fractures treated with plates or nails.
When determining radiographic union in distal femur or proximal tibia fractures, use RUST ≥ 10 or modified RUST ≥ 13 as the threshold for definite union — scores below these are ambiguous and should prompt clinical correlation.
Keep in mind that plate-fixed fractures unite at lower scores than nail-fixed fractures, so applying a single threshold without accounting for fixation method will overestimate healing in plated constructs.