McMaster University

McMaster University

Assessment of Radiographic Healing With Femoral Neck Fractures

We would like to share with you the most recent publication from the MacOrtho team. This paper, titled "Assessment of Radiographic Fracture Healing in Patients With Operatively Treated Femoral Neck Fractures", has been published in the Journal of Orthopaedic Trauma.

Find the abstract below and click here to access the full-version of the article.

Bhandari M, Chiavaras M, Ayeni O, Chakraverrty R, Parasu N, Choudur H, Bains S, Sprague S, Petrisor B. Assessment of Radiographic Fracture Healing in Patients With Operatively Treated Femoral Neck Fractures. J Orthop Trauma. 2013 Jan 2. [Epub ahead of print]


OBJECTIVES: This study was conducted to determine inter-rater and intra-rater reliability on healing assessment of femoral neck fractures between orthopedic surgeons and radiologists, as well as to test the performance of a checklist system for hip fracture healing.

METHODS: We developed and used a scoring system (RUSH score) to determine the validity of quantifying fracture healing. A panel of six reviewers (three orthopaedic surgeons and three radiologists) independently assessed fracture healing with the RUSH system using radiographs of 150 femoral neck fractures at various stages in healing on two occasions four weeks apart.

RESULTS: Using subjective assessment, the inter-rater agreement between reviewer groups for fracture healing was fair (ICC= 0.22, 95% CI:0.01-0.41) with no significant difference in agreement within the orthopaedic surgeon and radiologist groups (0.17 vs. 0.21). There was higher agreement for fracture healing using the RUSH score (ICC=0.53, 95% CI:0.30-0.69) compared to physician impression of healing, highlighting the difficulties with plain radiographic assessments of healing. Intra-rater agreement was consistently high across all measures for both surgeons and radiologists. The RUSH score and medial cortex bridging correlated well with overall assessment of healing (r=0.868 and 0.643, respectively).

CONCLUSIONS: The level of agreement between and within orthopaedic surgeon and radiologist reviewers in the assessment of fracture healing is low, though intra-rater agreement is high. The RUSH score shows promise as a tool to improve agreement on fracture healing. Studies evaluating reliability and accuracy of healing with clinical information and temporal evaluation are needed and may further improve agreement.

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