O'Halloran et al reported the Nonunion Risk Determination (NURD) score for evaluating a patient with a tibial fracture. It can help to identify a patient at increased risk for nonunion. The authors are from the University of Maryland in Baltimore.
Patient selection: tibial fracture
Parameters:
(1) percent cortical contact
(2) ASA status from 1 to 3
(3) sex
(4) specific types of fracture
(5) closed vs open fracture
(6) chronic disease (HIV, hepatitis C, diabetes mellitus)
(7) compartment syndrome
(8) flap coverage required
Parameter |
Finding |
Points |
percent cortical contact |
100% |
0 |
|
75% |
1 |
|
50% |
2 |
|
25% |
3 |
ASA |
ASA 1 |
1 |
|
ASA 2 |
2 |
|
ASA 3 |
3 |
sex |
female |
0 |
|
male |
1 |
specific type |
low-energy fracture |
-1 |
|
spiral pattern |
-1 |
|
other |
0 |
closed vs open |
closed |
0 |
|
open |
2 |
chronic disease |
no |
0 |
|
yes |
3 |
compartment syndrome |
no |
0 |
|
yes |
4 |
flap coverage required |
no |
0 |
|
yes |
5 |
where:
• There is some uncertainty in scoring.
• Low-energy and spiral fracture could be separate, but minimum score is given as 0 indicating that only one is allowed.
• The percent cortical contact percent does not cover the entire range.
total score =
= SUM(points for all 8 parameters)
Interpretation:
• minimum score: 0
• maximum score: 21
• The higher the score the greater the risk of nonunioon.
Score |
Percent Nonunion |
0 to 5 |
2% |
6 to 8 |
22% |
9 to 11 |
42% |
>= 12 |
61% |
Specialty: Emergency Medicine, Surgery, orthopedic