title: Radiographic scoring system to evaluate union of distal radius fractures.
abstract: OBJECTIVE
  To evaluate the intra- and interobserver reliability of a scoring system for distal radius fracture union based on specific radiographic parameters obtainable from x-rays.
  
  
  METHODS
  Two sets of 35 anteroposterior and lateral x-rays were obtained by retrospective review of consecutive patients with distal radius fractures (AO types A and C) treated by a single surgeon in 2009. One set was assembled for those patients treated nonsurgically and 1 set for those treated with open reduction and internal fixation (ORIF) with volar plating. Radius union scoring system (RUSS) scores were compiled from a 5-person review panel consisting of hand surgeons and musculoskeletal radiologists. Union of each of the 4 cortices was graded on a 3-point scale (0, fracture line visible with no callus; 1, callus formation but fracture line present; 2, cortical bridging without clear fracture line). Reviewers also recorded their overall impression of fracture union (united or not united). Each set of radiographs was reviewed twice by the 5 reviewers, 2 weeks apart. Inter- and intraobserver reliability were determined using intraclass correlation coefficients.
  
  
  RESULTS
  For nonsurgically treated fractures, substantial agreement in union scores was found with regard to both intra- and interobserver reliability. For fractures treated with ORIF, substantial agreement was found in union scores with regard to intraobserver reliability and moderate agreement with regard to interobserver reliability. In addition, when using the reviewers' overall assessment of union as a reference standard, RUSS had a statistically significant predictive value in being able to differentiate between united and not united fractures.
  
  
  CONCLUSIONS
  This radiographic union tool demonstrated substantial intra- and interobserver reliability for the determination of fracture union in the distal radius. The RUSS is a simple method for a standardized assessment of radiographic union of DRF treated nonsurgically or with ORIF.
  
  
  METHODS
  Economic/decision analysis IV.
authors.affiliation: Department of Orthopaedic Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Radiology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Anesthesia, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Shaun P
authors.initials: SP
authors.lastname: Patel
authors.affiliation: Department of Orthopaedic Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Radiology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Anesthesia, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Shawn G
authors.initials: SG
authors.lastname: Anthony
authors.affiliation: Department of Orthopaedic Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Radiology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Anesthesia, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.affiliation: Department of Orthopaedic Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Radiology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Anesthesia, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Manjiri M
authors.initials: MM
authors.lastname: Didolkar
authors.affiliation: Department of Orthopaedic Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Radiology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Anesthesia, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Kim
authors.affiliation: Department of Orthopaedic Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Radiology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Anesthesia, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Jim S
authors.initials: JS
authors.lastname: Wu
authors.affiliation: Department of Orthopaedic Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Radiology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Anesthesia, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Justin W
authors.initials: JW
authors.lastname: Kung
authors.affiliation: Department of Orthopaedic Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Radiology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Anesthesia, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Martin
authors.initials: M
authors.lastname: Dolan
authors.affiliation: Department of Orthopaedic Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Radiology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Anesthesia, Boston Children's Hospital, Boston, Massachusetts. Electronic address: trozenta@bidmc.harvard.edu.
authors.forename: Tamara D
authors.initials: TD
authors.lastname: Rozental
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017102:Fracture Healing; D006801:Humans; D008875:Middle Aged; D015588:Observer Variation; D011859:Radiography; D011884:Radius / Q000000981:diagnostic imaging*; D011885:Radius Fractures / Q000000981:diagnostic imaging* / Q000628:therapy; D015203:Reproducibility of Results; D012189:Retrospective Studies
keywords: Distal radius fracture; healing; radiograph; union