Application of the Radiographic Union Scale for Tibial fractures (RUST): Assessment of healing rate and time of tibial fractures managed with intramedullary nailing

Introduction: Tibial fractures are devastating injuries and a cause of significant morbidity. There is limited information describing the length of time it takes for these injuries to heal. The aim of this study was to define the normal distribution of healing times of a consecutive series of tibial fractures treated with intramedullary (IM) nailing by applying the Radiographic Union Scale for Tibial fractures (RUST). Methods: 880 radiographs from 217 patients were assessed with RUST. Patients requiring more than one standard deviation from the mean were defined to have a delayed union. Results: 16 patients (7%) developed non-unions and 30 patients (14%) had delayed union. Of the 201 patients who achieved union, the mean time to healing was 18.7 (SD 6.9) weeks, with a wide range from 7 to 52 weeks. In the union group, the rate of healing was greatest in the 8 to 12-week period. In contrast, in the delayed union group there was a lower peak rate of change, which was reached at a later time point. Discussion: Our data indicates that 7% of patients with tibial fractures treated with IM nailing develop non-unions and over 10% of those progressing to union will take longer than 26 weeks. The data on healing rates is important to surgeons and orthopaedic multidisciplinary staff in guiding management. It can also be of help for patients planning their finances and for giving estimates for personal injury claims. Crown Copyright (C) 2019 Published by Elsevier Masson SAS. All rights reserved.