{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T06:56:11Z","timestamp":1777964171768,"version":"3.51.4"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","funder":[{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"crossref","award":["SFB1444\/CRC1444"],"award-info":[{"award-number":["SFB1444\/CRC1444"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n            <jats:title>OBJECTIVES:<\/jats:title>\n            <jats:p>To evaluate the reliability of the modified Radiographic Union Score for Tibial fractures (mRUST) as a reliable tool for monitoring lower limb fractures (femur, tibia) treated with various modalities (nail, plate).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Design:<\/jats:title>\n            <jats:p>Retrospective analysis.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Setting:<\/jats:title>\n            <jats:p>Single center academic hospital in Germany.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Patient Selection Criteria:<\/jats:title>\n            <jats:p>Adult patients (\u226518 years) with extra-articular long bone fractures of the lower extremities treated surgically between January 2005 and April 2022, requiring radiographs in two perpendicular planes and at least one follow-up visit, were included. Exclusion criteria were critical clinical conditions, inability to consent, joint articulation fractures, inadequate documentation, or insufficient imaging quality.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Outcome Measures and Comparisons:<\/jats:title>\n            <jats:p>Six international investigators (five orthopedic surgeons, one radiologist) independently assessed fracture line and callus growth per cortex (mRUST) at individualized follow-up time points based on clinical practice. To evaluate interrater reliability, intraclass correlation coefficients were calculated for the overall dataset, and for subsets of rated images, that were defined based on anatomical location (femur\/tibia), treatment type (plate\/nail fixation), and treatment combinations across locations.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>A total of 166 patients (63 femur fractures, 103 tibia fractures; 32.5% female, mean age 43.4 (18\u201384)) with 1136 follow-up time points were analyzed. Overall interrater reliability for mRUST was good (intraclass correlation coefficient 0.77), consistent across fixation methods (nail\/plate fixation, 0.79) and anatomical locations (tibia, 0.78; femur, 0.81). Cortex-specific reliability varied, with highest agreement for the medial cortex (0.70\u20130.74) and lowest for the posterior cortex (0.65\u20130.74).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>The mRUST (radiographic score) demonstrated reliability for monitoring fracture healing in the femur and tibia, irrespective of fixation method, supporting its use as a generalizable tool across lower limb fractures.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>LEVEL OF EVIDENCE:<\/jats:title>\n            <jats:p>Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/bot.0000000000003032","type":"journal-article","created":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T18:00:09Z","timestamp":1750874409000},"page":"557-563","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Interobserver Reliability of the Modified Radiographic Union Score for Tibial and Femoral Fractures"],"prefix":"10.1097","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4534-0466","authenticated-orcid":false,"given":"Dominik","family":"Deppe","sequence":"first","affiliation":[{"name":"Julius Wolff Institute, Berlin Institute of Health at Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Berlin, Germany;"},{"name":"Department of Radiology, Charit\u00e9\u2014Universit\u00e4tsmedizin, Berlin, Germany;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matteo","family":"Gabriele","sequence":"additional","affiliation":[{"name":"Julius Wolff Institute, Berlin Institute of Health at Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Berlin, Germany;"},{"name":"Department of Electrical, Electronic, and Information Engineering - \u201cGuglielmo Marconi\u201d - \u201cDEI\u201d, Alma Mater Studiorum - Universit\u00e0 di Bologna, Cesena, Italy;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manuel Giovanni","family":"Mazzoleni","sequence":"additional","affiliation":[{"name":"Hip Department (CAD) Gaetano Pini - CTO Orthopedic Institute University of Milan, Milan, Italy;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alejandro","family":"Ordas-Bayon","sequence":"additional","affiliation":[{"name":"Servicio de Cirug\u00eda Ortop\u00e9dica y Traumatolog\u00eda, Hospital Universitario Ram\u00f3n y Cajal, Madrid, Spain;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Fidanza","sequence":"additional","affiliation":[{"name":"Orthopaedic and Trauma Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuriy","family":"Rozhko","sequence":"additional","affiliation":[{"name":"Julius Wolff Institute, Berlin Institute of Health at Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Berlin, Germany;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ekin Kaya","family":"\u015eim\u015fek","sequence":"additional","affiliation":[{"name":"Orthopaedics and Traumatology Specialists, Baskent University Hospital, Ankara, Turkey;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eran","family":"Keltz","sequence":"additional","affiliation":[{"name":"Division of Orthopedic Surgery, Rambam Health Care Campus, Haifa, Israel;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Georg","family":"Osterhoff","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philipp","family":"Damm","sequence":"additional","affiliation":[{"name":"Julius Wolff Institute, Berlin Institute of Health at Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Berlin, Germany;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Georg N.","family":"Duda","sequence":"additional","affiliation":[{"name":"Julius Wolff Institute, Berlin Institute of Health at Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Berlin, Germany;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marko","family":"Leskovar","sequence":"additional","affiliation":[{"name":"Zuse Institute Berlin (ZIB), Berlin, Germany; 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