{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T04:11:31Z","timestamp":1789618291352,"version":"build-2803163510"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:sec>\n            <jats:title>Objectives:<\/jats:title>\n            <jats:p>To report the progression of radiographic healing after intramedullary nailing of tibial shaft fractures using the Radiographic Union Score for Tibial fractures (RUST) and determine the ideal timing of early postoperative radiographs.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Design:<\/jats:title>\n            <jats:p>Retrospective case series.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Setting:<\/jats:title>\n            <jats:p>Urban academic Level 1 trauma center.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Patients\/Participants:<\/jats:title>\n            <jats:p>Three hundred three patients with acute tibial shaft fractures underwent intramedullary nailing between 2006 and 2013, met inclusion criteria, and had at least 3 months of radiographic follow-up.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Intervention:<\/jats:title>\n            <jats:p>Baseline demographic, injury, and surgical data were recorded for each patient. Each set of postoperative radiographs were scored using RUST and evaluated for implant failure.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Main Outcome Measurements:<\/jats:title>\n            <jats:p>Postoperative time distribution for each RUST score, RUST score distribution for 4 common follow-up time points, and the presence and timing of implant failure.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>The fifth percentile and median times, respectively, for reaching \u201cany radiographic healing\u201d (RUST = 5) was 4.0 weeks and 8.4 weeks, \u201cradiographically healed\u201d (RUST = 9) was 12.1 and 20.9 weeks, and \u201chealed and remodeled\u201d (RUST = 12) was 23.5 weeks and 47.7 weeks. At 6 weeks, 84% of radiographs were scored as RUST \u2264 6 (2 or fewer cortices with callus). No implant failure occurred within the first 8 weeks after surgery, and the indication for all 7 reoperations within this period was apparent on physical examination or immediate postoperative radiographs.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>The median time to radiographic union (RUST = 9) after tibial nailing was approximately 20 weeks, and little radiographic healing occurred within the first 8 weeks after surgery. Routine radiographs in this period may offer little additional information in the absence of clinical concerns such as new trauma, malalignment, or infection.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Level of Evidence:<\/jats:title>\n            <jats:p>Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/bot.0000000000002146","type":"journal-article","created":{"date-parts":[[2021,5,3]],"date-time":"2021-05-03T07:00:26Z","timestamp":1620025226000},"page":"e6-e11","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":12,"title":["Progression of Tibia Fracture Healing Using RUST: Are Early Radiographs Helpful?"],"prefix":"10.1097","volume":"36","author":[{"given":"Robert D.","family":"Wojahn","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Bechtold","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Washington University in St Louis, St. Louis, MO;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Torgom","family":"Abraamyan","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Oregon Health & Science University, Portland, OR;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Spraggs-Hughes","sequence":"additional","affiliation":[{"name":"School of Interdisciplinary Health Professions, Northern Illinois University, Chicago, IL;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Gardner","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Stanford University, Palo Alto, CA; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William M.","family":"Ricci","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery and Weill Cornell Medical College, New York, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher M.","family":"McAndrew","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Washington University in St Louis, St. Louis, MO;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20250614","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1097\/BOT.0000000000000390","article-title":"Determination of radiographic healing: an assessment of consistency using RUST and modified RUST in metadiaphyseal fractures","volume":"29","author":"Litrenta","year":"2015","journal-title":"J Orthop Trauma."},{"key":"R2-20250614","doi-asserted-by":"crossref","first-page":"e1091","DOI":"10.2106\/JBJS.K.01344","article-title":"Variability in the definition and perceived causes of delayed unions and nonunions: a cross-sectional, multinational survey of orthopaedic surgeons","volume":"94","author":"Bhandari","year":"2012","journal-title":"J Bone Joint Surg Am."},{"key":"R3-20250614","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1097\/00005131-200209000-00004","article-title":"A lack of consensus in the assessment of fracture healing among orthopaedic surgeons","volume":"16","author":"Bhandari","year":"2002","journal-title":"J Orthop Trauma."},{"key":"R4-20250614","doi-asserted-by":"crossref","first-page":"1862","DOI":"10.2106\/JBJS.G.01580","article-title":"Variability in the assessment of fracture-healing in orthopaedic trauma studies","volume":"90","author":"Corrales","year":"2008","journal-title":"J Bone Joint Surg Am."},{"key":"R5-20250614","doi-asserted-by":"crossref","first-page":"S76","DOI":"10.1097\/BOT.0b013e3181ca3f97","article-title":"When is a fracture healed? 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