title: The radiographic union scale in tibial (RUST) fractures: Reliability of the outcome measure at an independent centre.
abstract: OBJECTIVE
  The radiographic union score for tibial (RUST) fractures was developed by Whelan et al to assess the healing of tibial fractures following intramedullary nailing. In the current study, the repeatability and reliability of the RUST score was evaluated in an independent centre (a) using the original description, (b) after further interpretation of the description of the score, and (c) with the immediate post-operative radiograph available for comparison.
  
  
  METHODS
  A total of 15 radiographs of tibial shaft fractures treated by intramedullary nailing (IM) were scored by three observers using the RUST system. Following discussion on how the criteria of the RUST system should be implemented, 45 sets (i.e. AP and lateral) of radiographs of IM nailed tibial fractures were scored by five observers. Finally, these 45 sets of radiographs were rescored with the baseline post-operative radiograph available for comparison.
  
  
  RESULTS
  The initial intraclass correlation (ICC) on the first 15 sets of radiographs was 0.67 (95% CI 0.63 to 0.71). However, the original description was being interpreted in different ways. After agreeing on the interpretation, the ICC on the second cohort improved to 0.75. The ICC improved even further to 0.79, when the baseline post-operative radiographs were available for comparison.
  
  
  CONCLUSIONS
  This study demonstrates that the RUST scoring system is a reliable and repeatable outcome measure for assessing tibial fracture healing. Further improvement in the reliability of the scoring system can be obtained if the radiographs are compared with the baseline post-operative radiographs.Cite this article: Mr J.M. Leow. The radiographic union scale in tibial (RUST) fractures: Reliability of the outcome measure at an independent centre. Bone Joint Res 2016;5:116-121. DOI: 10.1302/2046-3758.54.2000628.
authors.affiliation: College of Medicine and Veterinary Medicine, University of Edinburgh, 11 Montague Street, Edinburgh EH8 9QT, UK leowjunmin@gmail.com.
authors.forename: J M
authors.initials: JM
authors.lastname: Leow
authors.affiliation: Trauma and Orthopaedics, Orthopaedic Department, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: N D
authors.initials: ND
authors.lastname: Clement
authors.affiliation: School of Medicine and Dentistry, University of Aberdeen, Westburn Dr, Aberdeen AB25 3BZ, UK.
authors.forename: T
authors.initials: T
authors.lastname: Tawonsawatruk
authors.affiliation: Trauma and Orthopaedics.
authors.forename: C J
authors.initials: CJ
authors.lastname: Simpson
authors.affiliation: Department of Orthopaedics, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, UK.
authors.forename: A H R W
authors.initials: AH
authors.lastname: Simpson
keywords: interobserver reliability; intramedullary fixation; radiographic union; score; tibial fractures