title: Development of a Radiographic Union Score for Determining Osteotomy Union Rates in Long Bones of the Foot.
abstract: Determining the status of bone healing after osteotomy can be challenging and has implications ranging from clinical decision-making to standardization of research outcomes without the use of computed tomography. To date, no method has been validated for determining osseous healing of an osteotomy site of the long bones of the foot. The purpose of the present study was to develop a radiographic union scoring system that would enhance the diagnostic healing assessment. We adapted existing orthopedic scales that had been validated for healing in the leg for application in the long bones of the foot. One hundred cases were evaluated by 6 blinded assessors to test the inter- and intrarater reliability of the subjective healing assessment compared with the proposed scoring system. The radiographs were classified by postoperative period: ≤4, 5 to 12, and >12 weeks. The proposed scale had a high interrater reliability but was burdensome. Using a priori item reduction protocols, the scale was limited to the 5 items with the best internal consistency, which significantly reduced the burden. The result was excellent interrater reliability (α = 0.87) among all assessors compared with acceptable reliability (α = 0.66) for the subjective osteotomy healing assessment. The intrarater reliability during the subsequent retest phase demonstrated similar relationships, with low agreement (r = 0.38) for subjective healing. Each of the items included in the final scoring scale had moderate to good agreement across all assessors (r = 0.51 to 0.63). The reliability of this system appeared superior to the subjective assessment of osseous healing alone, even in the absence of clinical correlates after an osteotomy in the foot.
authors.affiliation: Chief Resident, Division of Podiatric Surgery, Department of Surgery, Mount Auburn Hospital, Cambridge, MA; and Clinical Fellow, Department of Surgery, Harvard Medical School, Boston, MA. Electronic address: nsummers@mah.harvard.edu.
authors.forename: N Jake
authors.initials: NJ
authors.lastname: Summers
authors.affiliation: Chief Resident, Division of Podiatric Surgery, Department of Surgery, Mount Auburn Hospital, Cambridge, MA; and Clinical Fellow, Department of Surgery, Harvard Medical School, Boston, MA.
authors.forename: Jill
authors.initials: J
authors.lastname: Ashcraft
authors.affiliation: Clinical Fellow, Department of Surgery, Harvard Medical School, Boston, MA.
authors.forename: Homan
authors.initials: H
authors.lastname: Badri
authors.affiliation: Clinical Fellow, Department of Surgery, Harvard Medical School, Boston, MA.
authors.forename: John
authors.initials: J
authors.lastname: Mostafa
authors.affiliation: Clinical Fellow, Department of Surgery, Harvard Medical School, Boston, MA.
authors.forename: Brandon
authors.initials: B
authors.lastname: Barrett
authors.affiliation: Clinical Fellow, Department of Surgery, Harvard Medical School, Boston, MA.
authors.forename: Michael
authors.initials: M
authors.lastname: Sganga
authors.affiliation: Instructor, Department of Surgery, Harvard Medical School, Boston, MA; and Director of Research and Quality Assurance, Division of Podiatric Surgery, Department of Surgery, Mount Auburn Hospital, Cambridge, MA.
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: Cook
authors.affiliation: Instructor, Department of Surgery, Harvard Medical School, Boston, MA; and Chief, Division of Podiatric Surgery, Department of Surgery, Mount Auburn Hospital, Cambridge, MA.
authors.forename: Philip
authors.initials: P
authors.lastname: Basile
authors.affiliation: Instructor, Department of Surgery, Harvard Medical School, Boston, MA; and Director of Residency Training, Division of Podiatric Surgery, Department of Surgery, Mount Auburn Hospital, Cambridge, MA.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Cook
mesh_terms: D001863:Bone Screws; D015331:Cohort Studies; D005260:Female; D005529:Foot Bones / Q000000981:diagnostic imaging* / Q000293:injuries / Q000601:surgery; D017102:Fracture Healing / Q000502:physiology*; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D005599:Fractures, Ununited / Q000517:prevention & control; D006801:Humans; D008297:Male; D015588:Observer Variation; D010027:Osteotomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D011446:Prospective Studies; D011859:Radiography; D015203:Reproducibility of Results; D016896:Treatment Outcome
keywords: bone healing; long bone; osteotomy; radiograph; union rate