Reliability of Using Radius Union Scoring System among General Practitioners, Orthopedic Residents and Orthopedic Surgeons for Distal End Radius Fracture Healing Evaluation
Nattakorn Mahasupachai MD*, Thitinut Dilokhuttakarn MD*
Affiliation : * Department of Orthopedic Surgery, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
Background : Fractures of distal end of radius are common fractures in adults. They were commonly treated by general
practitioners (GPs) in rural Thailand. Inadequate time for immobilization and casting may reach more complications such
as failure to maintain reduction or stiffness. There has been no publication of objective tools for diagnosing of fracture union
to date. Radius union scoring system (RUSS) may be a good diagnostic tool and easy to use. However, there is no study about
the reliability between GPs and orthopedic surgeons.
Objective : To study the reliability of using RUSS score between different evaluators-GPs and orthopedic surgeons.
Material and Method: Anteroposterior and lateral view of plain wrist radiographs from 20 distal end radius fractured
patients were used for reviewing. RUSS was used for rating of radiographs by 6 GPs, 6 orthopedic residents and 3 orthopedic
surgeons. Interobserver reliability was determined and calculated.
Results : This study found low level of interobserver between GPs and orthopedic surgeons (ICC = 0.39, 95% CI) and low
level of interobserver reliability in inexperienced groups of physicians in this study (ICC = 0.37 and 0.48 in GPs and junior
residents’ group). Level of interobserver reliability has been associated with rater’s experience.
Conclusion : Level of interobserver reliability between general practitioners and orthopedic surgeons was low due to
experiences of the raters. RUSS may not be a proper tool for inexperienced physicians.
Keywords : Distal radius fracture, Fracture union, General practitioners, Radius union scoring system
