OTA 2012 Posters

Scientific Poster #23 Hip/Femur OTA-2012

Assessment of Radiographic Fracture Healing in Patients With Operatively Treated Femoral Neck Fractures

Brad A. Petrisor, MD, FRCSC1; Olufemi R. Ayeni, MD, FRCSC1; Simrit Bains, MA1;
Rajesh Chakravertty, MD, FRCSC2; Meg Chiavaras, MD, PhD, FACR, FRCPC3;
Hema N. Choudur, MBBS, FRCPC3; Naveen Parasu, MBBS, FRCR, FRCPC3; Mohit Bhandari, MD, PhD, FRCSC1; on behalf of the Assessment Group for
Radiographic Evaluation and Evidence (AGREE) Study Group;
1Department of Surgery, McMaster University, Hamilton, Ontario, Canada;
2Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada;
3Department of Radiology, McMaster University, Hamilton, Ontario, Canada

Purpose: The reliability of assessing fracture healing in femoral neck fractures has not been adequately addressed in both research and surgical practice. The accurate assessment of fracture healing is vital in both patient care and in outcomes of clinical research. The purpose of the present study was to determine the reliability of fracture healing assessment and the validity of a novel Radiographic Union Scale for Hip (RUSH) fracture score.

Methods: A panel of 6 reviewers (3 orthopaedic surgeons and 3 radiologists) independently assessed fracture healing for 150 femoral neck fractures at two separate occasions with a time lapse of 4 weeks to determine interrater and intrarater reliability. Assessment was performed using radiographs for each case at a single time point at various stages of healing. The RUSH score was developed based on the existing criteria and definitions of hip fracture healing, and as such incorporated the assessment of callus bridging and disappearance, trabecular consolidation, and trabecular disappearance. Reviewers used this to score each fracture on a scale from 10 to 30. This would help to determine the validity of using this system to quantify hip fracture healing.

Results: Using subjective assessment of fracture healing, the interrater agreement between all reviewers for fracture healing was low (intraclass correlation coefficient [ICC] = 0.32, 95% confidence interval [CI]: 0.20-0.46) with no significant difference between the orthopaedic surgeon and radiologist groups (0.27 vs 0.31). There was higher agreement for fracture healing using the RUSH score (ICC = 0.63, 95% CI: 0.34-0.79) when compared to physician assessment of healing (ICC = 0.37, 95% CI: 0.10-0.59). Intrarater agreement was consistently high across all measures for both surgeons and radiologists. The RUSH score and medial cortex bridging correlated well with the overall assessment of healing (Pearson correlation (r) = 0.868 and 0.643, respectively). Less than 2 weeks after surgery, 6 of 7 (85.7%) fractures were deemed healed by reviewers.

Conclusion: In the absence of time of radiographic evaluation, the level of agreement between and within orthopaedic surgeon and radiologist reviewers in the assessment of fracture healing is low, although intrarater agreement is high. Assessments were improved with the use of a simple radiological checklist (RUSH). Studies evaluating reliability and accuracy of healing with clinical information and temporal evaluation are needed and may further improve agreement.

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.