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. 2022 Jun;14(3):295-303.
doi: 10.1177/17585732211033154. Epub 2021 Jul 27.

A comparative study of 6-week and 12-week Radiographic Union Scores for HUmeral fractures (RUSHU) as a predictor of humeral shaft non-union

Borna Guevel  1 , Kishan Gokaraju  1 , Foad Mohamed  1 , Frederik Sorensen  1 , Elizabeth Gillott  1 , Peter Domos  1
Affiliations

A comparative study of 6-week and 12-week Radiographic Union Scores for HUmeral fractures (RUSHU) as a predictor of humeral shaft non-union

Borna Guevel et al. Shoulder Elbow. 2022 Jun.

Abstract

Background: Non-union in non-operatively managed humeral shaft fractures are associated with significant morbidity. Hence, developing a robust system that could help with early diagnosis is important. We aimed to evaluate the validity of the Radiographic Union Score for HUmeral fractures (RUSHU) at 6 weeks (RUSHU-6) and test whether a RUSHU at 12 weeks (RUSHU-12) would be a better predictor of non-union.

Methods: We retrospectively reviewed all non-operatively managed humeral diaphyseal fractures from 2012 to 2018. Statistical analysis was used to determine the cut-off RUSHU-12 and evaluate the effect of RUSHU-6 and RUSHU-12 on non-union prediction.

Results: In sum, 32 patients had radiographs at 6 weeks post-injury, 27 of which also had radiographs at 12 weeks. A RUSHU cut-off of 9 was the best predictor of non-union at 12 weeks. Only RUSHU-12 had a statistically significant influence predicting non-union (P = 0.011) and there was a significant correlation (P = 0.003) between score progression from RUSHU-6 to RUSHU-12 and the development of non-union.

Discussion: A RUSHU-12 of <9 and a low score progression between 6 and 12 weeks suggest superior predictive value in determining the likelihood of non-union. Further validation in the form of a large multicentred study is however required.

Keywords: Humerus; RUSHU; diaphysis; non-operative; non-union.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Examples of different Radiographic Union Scores for HUmeral fractures (RUSHU). (a) RUSHU 4 (b) RUSHU 8 (c) RUSHU 12.
Figure 2.
Figure 2.
Flow chart depicting the use of inclusion and exclusion criteria on selecting final patient cohort.
Figure 3.
Figure 3.
Receiver operating characteristic (ROC) curve for the Radiographic Union Score for HUmeral fracture (RUSHU) cut-off score of 9.
Figure 4.
Figure 4.
Interval change between 6- and 12-week Radiographic Union Scores for HUmeral Fractures (RUSHU) scores for union and non-union.
See this image and copyright information in PMC

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