Year: 2026 | Month: July | Volume: 16 | Issue: 7 | Pages: 252-258
DOI: https://doi.org/10.52403/ijhsr.20260726
Reliability of the Radiographic Union Scale for Tibial Fractures (RUST) in Assessing Fracture Healing Following Intramedullary Interlocking Nailing: A Prospective Observational Study
Aditya Sharma1, Apser Khan2, Sanjay Gupta3, Devansh Agarwal4, Harshvardhan Buddhist5
1-5Department of Orthopaedics, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India.
Corresponding Author: Apser Khan
ABSTRACT
Assessment of fracture union following intramedullary interlocking nailing is essential for guiding rehabilitation and clinical decision-making. Conventional radiographic evaluation is subjective and associated with considerable inter-observer variability. The Radiographic Union Scale for Tibial fractures (RUST) was developed to provide a standardized and objective method for assessing radiographic fracture healing.
Objective: To evaluate the inter-observer reliability of the Radiographic Union Scale for Tibial fractures (RUST) in assessing fracture healing after intramedullary interlocking nailing.
Materials and Methods: A prospective observational study was conducted in the Department of Orthopaedics at Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, India, between April 2024 and September 2025. Thirty-seven adult patients with tibial shaft fractures treated with intramedullary interlocking nailing were included. Standardized anteroposterior and lateral radiographs obtained at 6, 12, and 24 weeks postoperatively were independently assessed by five orthopedic surgeons and two orthopedic senior residents and one radiologist using the RUST scoring system. Inter-observer reliability was evaluated using the Intraclass Correlation Coefficient (ICC) with 95% confidence intervals (CI).
Results: The mean age of the participants was 38.03 ± 15.01 years, and 86.5% were males. Mean RUST scores increased progressively during follow-up, ranging from 5.27–5.51 at 6 weeks, 7.49–8.35 at 12 weeks, and 11.08–11.32 at 24 weeks. Inter-observer reliability improved over time, with an ICC of 0.800 (95% CI: 0.668–0.887) at 6 weeks, 0.945 (95% CI: 0.910–0.969) at 12 weeks, and 0.977 (95% CI: 0.961–0.987) at 24 weeks. The overall inter-observer reliability was excellent (ICC = 0.953; 95% CI: 0.928–0.973).
Conclusion: The Radiographic Union Scale for Tibial fractures demonstrated excellent inter-observer reliability in assessing fracture healing following intramedullary interlocking nailing. Observer agreement improved with advancing fracture healing, supporting the use of RUST as a simple, objective, and reproducible tool for routine clinical practice and orthopedic research.
Key words: Tibial shaft fracture; Radiographic Union Scale for Tibial fractures (RUST); Intramedullary interlocking nailing; Fracture healing; Inter-observer reliability; Intraclass correlation coefficient.