Skip to main content
Erschienen in:

02.06.2017 | Original Article

The Non-Union Scoring System: an interobserver reliability study

verfasst von: M. van Basten Batenburg, I. B. Houben, T. J. Blokhuis

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 1/2019

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The Non-Union Scoring System (NUSS) aims to classify non-unions according to their severity and relate them to four treatment categories. The main purpose of this study was to evaluate the reliability of the NUSS. In addition we assessed its clinical validity.

Methods

Forty-four Patients with a tibia non-union between 2005 and 2015 were included in this study. Data from all included patients were scored independently by three observers according to the NUSS criteria. The interobserver agreement was evaluated using the intraclass correlation coefficient (ICC). The interobserver agreement of the Weber–Cech system was assessed using Fleiss’ kappa. Finally, the clinical validity of the NUSS was analysed by comparing outcomes of the actual treatment groups to the proposed treatment groups following from the NUSS scores.

Results

Forty-four patients were included. The comparison of NUSS scores between observers showed substantial agreement [ICC; 0.78 (0.67–0.86)]. The comparison of the Weber–Cech classification between observers showed only fair agreement [Fleiss κ; 0.30 (0.17–0.42)]. The χ2 test for the treatment groups according to the NUSS and the treatments at index procedure showed an independent relation (χ2 = 5.794, 6 degrees of freedom, p: 0.447). In contrast, the proposed treatment strategy corresponds well to the definitive treatment (χ2 = 29.963, 9 degrees of freedom, p < 0.001).

Conclusion

We conclude that the NUSS is both a reliable and valid system to classify non-unions.
Literatur
1.
Zurück zum Zitat Antonova E, Le TK, Burge R, Mershon J. Tibia shaft fractures: costly burden of nonunions. BMC Musculoskelet Disord. 2013;26(14):42.CrossRef Antonova E, Le TK, Burge R, Mershon J. Tibia shaft fractures: costly burden of nonunions. BMC Musculoskelet Disord. 2013;26(14):42.CrossRef
2.
Zurück zum Zitat Patil S, Montgomery R. Management of complex tibial and femoral nonunion using the Ilizarov technique, and its cost implications. J Bone Joint Surg Br. 2006;88(7):928–32.CrossRefPubMed Patil S, Montgomery R. Management of complex tibial and femoral nonunion using the Ilizarov technique, and its cost implications. J Bone Joint Surg Br. 2006;88(7):928–32.CrossRefPubMed
3.
Zurück zum Zitat Santolini E, West R, Giannoudis PV. Risk factors for long bone fracture non-union: a stratification approach based on the level of the existing scientific evidence. Injury. 2015;46(Suppl 8):S8–19.CrossRefPubMed Santolini E, West R, Giannoudis PV. Risk factors for long bone fracture non-union: a stratification approach based on the level of the existing scientific evidence. Injury. 2015;46(Suppl 8):S8–19.CrossRefPubMed
4.
Zurück zum Zitat Harwood PJ, Newman JB, Michael ALR. (ii) An update on fracture healing and non-union. Orthop Trauma. 2010;24(1):9–23.CrossRef Harwood PJ, Newman JB, Michael ALR. (ii) An update on fracture healing and non-union. Orthop Trauma. 2010;24(1):9–23.CrossRef
5.
Zurück zum Zitat Calori GM, Phillips M, Jeetle S, Tagliabue L, Giannoudis PV. Classification of non-union: need for a new scoring system? Injury. 2008;39(Suppl 2):S59–63.CrossRefPubMed Calori GM, Phillips M, Jeetle S, Tagliabue L, Giannoudis PV. Classification of non-union: need for a new scoring system? Injury. 2008;39(Suppl 2):S59–63.CrossRefPubMed
6.
Zurück zum Zitat Weber BG, Cech O. Pseudarthrosis. New York: Grune and Stratton; 1976. Weber BG, Cech O. Pseudarthrosis. New York: Grune and Stratton; 1976.
7.
Zurück zum Zitat Reed AA, Joyner CJ, Brownlow HC, Simpson AH. Human atrophic fracture non-unions are not avascular. J Orthop Res. 2002;20(3):593–9.CrossRefPubMed Reed AA, Joyner CJ, Brownlow HC, Simpson AH. Human atrophic fracture non-unions are not avascular. J Orthop Res. 2002;20(3):593–9.CrossRefPubMed
8.
Zurück zum Zitat Brownlow HC, Reed A, Simpson AH. The vascularity of atrophic non-unions. Injury. 2002;33(2):145–50.CrossRefPubMed Brownlow HC, Reed A, Simpson AH. The vascularity of atrophic non-unions. Injury. 2002;33(2):145–50.CrossRefPubMed
9.
Zurück zum Zitat Panteli M, Pountos I, Jones E, Giannoudis PV. Biological and molecular profile of fracture non-union tissue: current insights. J Cell Mol Med. 2015;19(4):685–713.CrossRefPubMedPubMedCentral Panteli M, Pountos I, Jones E, Giannoudis PV. Biological and molecular profile of fracture non-union tissue: current insights. J Cell Mol Med. 2015;19(4):685–713.CrossRefPubMedPubMedCentral
10.
Zurück zum Zitat Catagni MA, Bianci-Maiocchi A. Treatment of fractures, non-unions, and bone loss of the tibia with the Ilizarov method. Milan: Medicalplastic; 1998. Catagni MA, Bianci-Maiocchi A. Treatment of fractures, non-unions, and bone loss of the tibia with the Ilizarov method. Milan: Medicalplastic; 1998.
11.
Zurück zum Zitat Paley D, Catagni MA, Argnani F, Villa A, Benedetti GB, Cattaneo R. Ilizarov treatment of tibial nonunions with bone loss. Clin Orthop Relat Res. 1989;241(241):146–65. Paley D, Catagni MA, Argnani F, Villa A, Benedetti GB, Cattaneo R. Ilizarov treatment of tibial nonunions with bone loss. Clin Orthop Relat Res. 1989;241(241):146–65.
12.
Zurück zum Zitat Giannoudis PV, Einhorn TA, Marsh D. Fracture healing: the diamond concept. Injury. 2007;38(Suppl 4):S3–6.CrossRefPubMed Giannoudis PV, Einhorn TA, Marsh D. Fracture healing: the diamond concept. Injury. 2007;38(Suppl 4):S3–6.CrossRefPubMed
13.
Zurück zum Zitat Calori GM, Colombo M, Mazza EL, Mazzola S, Malagoli E, Marelli N, et al. Validation of the Non-Union Scoring System in 300 long bone non-unions. Injury. 2014;45(Suppl 6):S93–7.CrossRefPubMed Calori GM, Colombo M, Mazza EL, Mazzola S, Malagoli E, Marelli N, et al. Validation of the Non-Union Scoring System in 300 long bone non-unions. Injury. 2014;45(Suppl 6):S93–7.CrossRefPubMed
14.
Zurück zum Zitat Kooistra BW, Sprague S, Bhandari M, Schemitsch EH. Outcomes assessment in fracture healing trials: a primer. J Orthop Trauma. 2010;24(Suppl 1):S71–5.CrossRefPubMed Kooistra BW, Sprague S, Bhandari M, Schemitsch EH. Outcomes assessment in fracture healing trials: a primer. J Orthop Trauma. 2010;24(Suppl 1):S71–5.CrossRefPubMed
15.
Zurück zum Zitat Jackowski D, Guyatt G. A guide to health measurement. Clin Orthop Relat Res. 2003;413(413):80–9.CrossRef Jackowski D, Guyatt G. A guide to health measurement. Clin Orthop Relat Res. 2003;413(413):80–9.CrossRef
16.
Zurück zum Zitat Abumunaser LA, Al-Sayyad MJ. Evaluation of the calori et Al nonunion scoring system in a retrospective case series. Orthopedics. 2011;34(5):359.PubMed Abumunaser LA, Al-Sayyad MJ. Evaluation of the calori et Al nonunion scoring system in a retrospective case series. Orthopedics. 2011;34(5):359.PubMed
17.
Zurück zum Zitat Whelan DB, Bhandari M, Stephen D, Kreder H, McKee MD, Zdero R, et al. Development of the radiographic union score for tibial fractures for the assessment of tibial fracture healing after intramedullary fixation. J Trauma. 2010;68(3):629–32.CrossRefPubMed Whelan DB, Bhandari M, Stephen D, Kreder H, McKee MD, Zdero R, et al. Development of the radiographic union score for tibial fractures for the assessment of tibial fracture healing after intramedullary fixation. J Trauma. 2010;68(3):629–32.CrossRefPubMed
18.
Zurück zum Zitat Walter SD, Eliasziw M, Donner A. Sample size and optimal designs for reliability studies. Stat Med. 1998;17(1):101–10.CrossRefPubMed Walter SD, Eliasziw M, Donner A. Sample size and optimal designs for reliability studies. Stat Med. 1998;17(1):101–10.CrossRefPubMed
19.
Zurück zum Zitat Fleiss JL, Cohen J. The equivalence of weighted kappa and the intraclass correlation coefficient as measures of reliability. Educ Psychol Meas. 1973;33:613–9.CrossRef Fleiss JL, Cohen J. The equivalence of weighted kappa and the intraclass correlation coefficient as measures of reliability. Educ Psychol Meas. 1973;33:613–9.CrossRef
20.
Zurück zum Zitat Fleiss JL. Measuring nominal scale agreement among many raters. Psychol Bull. 1971;76(5):378–82.CrossRef Fleiss JL. Measuring nominal scale agreement among many raters. Psychol Bull. 1971;76(5):378–82.CrossRef
21.
Zurück zum Zitat Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–74.CrossRefPubMed Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–74.CrossRefPubMed
22.
Zurück zum Zitat Bhandari M, Fong K, Sprague S, Williams D, Petrisor B. Variability in the definition and perceived causes of delayed unions and nonunions: a cross-sectional, multinational survey of orthopaedic surgeons. J Bone Joint Surg Am. 2012;94(15):e1091–6.CrossRefPubMed Bhandari M, Fong K, Sprague S, Williams D, Petrisor B. Variability in the definition and perceived causes of delayed unions and nonunions: a cross-sectional, multinational survey of orthopaedic surgeons. J Bone Joint Surg Am. 2012;94(15):e1091–6.CrossRefPubMed
Metadaten
Titel
The Non-Union Scoring System: an interobserver reliability study
verfasst von
M. van Basten Batenburg
I. B. Houben
T. J. Blokhuis
Publikationsdatum
02.06.2017
Verlag
Springer Berlin Heidelberg
Erschienen in
European Journal of Trauma and Emergency Surgery / Ausgabe 1/2019
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-017-0796-4

Weitere Artikel der Ausgabe 1/2019

European Journal of Trauma and Emergency Surgery 1/2019 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie erweitert durch Fallbeispiele, Videos und Abbildungen. Zur Fortbildung und Wissenserweiterung, verfasst und geprüft von Expertinnen und Experten der Gesellschaft für Arthroskopie und Gelenkchirurgie (AGA).


Jetzt entdecken!

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Morbus Dupuytren: Kollagenase-Injektion versus partielle Aponeurektomie

In der Behandlung von mittelschweren Dupuytren-Kontrakturen können Kollagenase-Injektionen von der Wirksamkeit her nicht mit der limitierten Aponeurektomie mithalten. Das hat der direkte Vergleich der beiden Methoden in der DISC-Studie ergeben.

Neue Osteoporose-Leitlinie: Frakturinzidenz senken, Versorgung verbessern

Das sind – zusammen mit dem Erhalt bzw. der Verbesserung der Funktionsfähigkeit und Lebensqualität der Patientinnen und Patienten – die Ziele der 2023er Leitlinie der Osteologischen Fachgesellschaften e.V. (DVO). Noch fremdeln viele Ärztinnen und Ärzte mit den neuen Konzepten und Risikotabellen. 

Myositiden – Fortschritte bei der Risikostratifizierung und Diagnostik

Bei der Myositis hat sich viel getan, was für den klinischen Alltag relevant ist – so Prof. Dr. Britta Maurer, Universitätsspital Bern, beim Deutschen Rheumatologiekongress 2024. Morbidität und Mortalität könnten zurückgehen.

Mesenchymale Stammzellen praktisch nutzlos gegen Gonarthrose

Die Idee, mit mesenchymalen Stammzellen arthrotische Kniegelenke zu regenerieren, klingt vielversprechend. Entsprechend zahlreich sind die Angebote dafür. Die Therapie ist allerdings nicht ganz billig – und vermutlich ohne großen Effekt, wie eine Metaanalyse einschlägiger Studien zeigt.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.